Vik Bakhru, MD, formerly ConsejoSano, now Circulo Health, on the value of culturally competent care

Dr. Vik Bakhru has spent his career as a physician-entrepreneur, focused on delivering health care to traditionally underserved communities. After founding various successful not-for-profit and for-profit organizations targeted at improving access to healthcare, Vik joined ConsejoSano as the COO and CFO. ConsejoSano provides patient engagement tools to payers and providers to help them better connect with their multicultural Medicaid/ Medicare patient populations. Their services include multi-channel messaging, care navigation, as well as data insights and consultancy services to increase patient engagement, reduce unnecessary medical spend, and produce better health outcomes. As the global pandemic continues to disproportionately affect communities of color in the US, ConsejoSano has found itself at the center of a difficult discussion of how to create trust in a medical system that has historically grossly mistreated marginalized groups, especially Black, Asian, Latinx, and Native American communities.

After leading ConsejoSano to a successful Series B raise, Vik is joining Circulo Health as the founding Chief Medical Officer. Circulo just raised $50M dollars as part of their Series A raise led by Drive Capital, General Catalyst, Oak HC/FT, and SVB Capital to enter into the Managed Medicaid space with their partner Olive.

During medical school at The George Washington University, Vik founded the Foundation for International Medical Relief of Children which was focused on opening clinics in areas of low health care access in Latin America. After graduation, Vik moved to Central America to support these efforts and built the organization up to over 10 pediatric and women’s health ambulatory centers across 8 countries with over 3000 full-time staff and volunteers when he left in 2010. After spending a few years managing P&Ls and working as a physician leader, Vik jumped back into the entrepreneurial world with First Opinion, an early telehealth startup, where he served as the COO during several successful rounds of fundraising before departing in early 2017 to join ConsejoSano.

In this episode, we discussed:

• Vik’s exclusive announcement that he is leaving his role with ConsejoSano to join Circulo as the founding Chief Medical Officer
• How powerful women in Vik’s life, both his grandmother and mother, inspired him to dedicate his life to serving the underserved
• The challenges ConsejoSano faced building trust in the medical system during the Covid-19 pandemic as well as the operational challenges of experiencing dramatic growth during an uncertain time
• The early opportunities for Circulo in the managed Medicaid space, including how you can use digital solutions create better member experiences for diverse communities

Start — 5:00 — Vik’s announcement and inspiration for addressing health inequity

• On leaving ConsejoSano to join Circulo: Vik has made the difficult decision to leave ConsejoSano to join Circulo Health, one of the nation’s newest health plans, to build a Medicaid focused health plan from the ground up. Vik wants to bring a better member and provider experience to the Medicaid ecosystem. Vik believes that the historic underinvestment in Medicaid has left an opportunity for a digital-first product that can help tailor care to the unique needs of this diverse population.
• Powerful women in Vik’s life as a source of inspiration: Vik has seen that health equity is not just providing greater access to healthcare, it is about building a relationship with each individual person you are trying to serve and providing them with the right tools/ resources in that moment of need. Vik recounts a story about being in the car with his mom in upstate New York. He lived in a rural area that was proud to have both a Home Depot and a Lowe’s in the same town. As they were driving, Vik spotted an older car that was in bad shape. When Vik pointed this out to his mom, suggesting this person should do something about it, she pulled the car over, grabbed his chin, and looked Vik straight in the eyes to explain that there are real inequalities that exist in our society, and that things are sometimes different for different families, and how blessed and fortunate they were to have food on the table, a roof over their heads, and opportunities for education that he states are basic human rights. As Vik ties this back to healthcare, he says that healthcare is also a human right.
• In addition to his mother, Vik had a strong relationship with his grandmother, who was a civil rights leader and a teacher in India. Vik’s grandmother grew up during a time when British rule was ending in India and Pakistan. During this time, she sold bangles and supported the civil rights movements led by Gandhi. Vik saw from both his mother and his grandmother that it is not okay to just let the status quo evolve and that it’s important that he works for underserved populations to do better.

“Health equity is not about providing equal access to the same tools to improve health. It’s more about understanding where someone is in their journey, and how do you meet them where they’re at? How do you bring the tools, resources, and capabilities of our healthcare system to achieve the same outcomes”

• Founding the Foundation for International Medical Relief of Children: Early in Vik’s medical training at GW, Vik was excited about the entrepreneurial opportunity to do good while solving a market need. The FIMRC establishes and operates clinics in Central America that are typically staffed at least partially using a medical volunteer model. The business model for the foundation didn’t rely on grants or donations and instead was funded by individuals traveling to the project sites that were established. They differentiated by expanding the volunteer market to include non-medical volunteers, including in some cases, the partners and children of the volunteers. As a result of this decision, they were able to attract leaders and talent that fueled their growth.

15:00–32:00 — The challenges of building trust in the medical system during a global pandemic

• Mission of ConsejoSano: The problem that Vik sees ConsejoSano addressing is that the healthcare system was not built to serve in a culturally relevant way. While he concedes the healthcare system does well in certain pockets of need, such as the Federally Qualified Health Centers (FQHCs), the growing diversity in our country demands services that are able to meet individuals where they’re at. ConsejoSano’s role is to serve as an intermediary between the healthcare system and the various populations that require those services by providing education, awareness, and care coordination services for over 25 different languages and cultures.
• Vik uses the analogy of Netflix movie/TV show recommendations to suggest that healthcare personalization is possible if there are enough data elements to distill things like culture, tradition, and beliefs. Vik believes these types of data elements will enable personalization in how/when care is delivered that will allow certain actors in the healthcare ecosystem to build a trusted relationship that will drive greater engagement and better outcomes.

“Your culture, your attitudes, beliefs, traditions, values, these are the nuts and bolts of what drives your decision making and your behavior with regards to your own health, and even more broadly in your life”

• Dramatic growth before the pandemic: Vik first wanted to highlight that while the pandemic has certainly further emphasized the value of providing culturally relevant services, that much of their growth actually occurred before its onset. With partners like Anthem, United, Molina, Centene, and Humana, they scaled from 30,000 patients on contract in 2017 to over 150 million Americans today, with much of that growth coming in late 2019.
• Building trust in the medical system for underserved communities during a pandemic: The pandemic has disproportionately affected racial and ethnic minority groups. In March and April, when the pandemic was first reaching the US, Vik saw a tremendous amount of fear. In response to this fear, Vik re-emphasized the need for a relationship focused technology platform. One of the things ConsejoSano started to do was send out SMS messages and even sometimes outbound calls to address these fears and let individuals know that they have support. At this point, Vik jokingly asks that investors cover their ears as they may not see the unit economics of these activities the same way that he does. While Vik acknowledges the unit economics may be difficult to measure, he firmly believes that there is an ROI in investing to build a relationship with the patient. ConsejoSano took on a strong role in providing education and awareness around the pandemic in a culturally relevant way — with a focus on language sensitivity and reliability. In a single quarter in the summer of 2020, ConsejoSano was doing 4x the total volume they had done in 2019.

“Investors, please put your hands over your ears at this moment, because you don’t like the unit economics and I get it, but it is needed. We must serve those who don’t have access to a cell phone or for whom we don’t yet have a cell phone number, but I make the call and if we’re able to get a cell phone number and convert, it’s worth the upfront investment, there is an ROI there.”

• Towards the second half of 2020, Vik describes the team’s focus shifting more towards scheduling telemedicine appointments and raising awareness about the ability of individuals to participate in the services offered in the FQHC setting given recent regulatory changes. In more personal terms, the team shifted the tone of messaging towards the end of 2020 to one of hope instead of fear. Vik described how they began reaching back out to the same individuals they had contacted at the beginning of the pandemic to raise awareness about the forthcoming vaccine and to attempt to close the gap on individuals who may have vaccine hesitancy. Vik believes this hesitancy can be best addressed by having a trusted voice at the table that can help patients answer the questions that are on their mind.
• Business/operational challenges of growing as quickly as they have: Vik, at this point, would appreciate it if you looked back at the headshot of him earlier in this blog post and imagined him with more hair than he had before the pandemic. The biggest issue Vik discussed was the lack of access to capital through some part of this journey. As Vik saw patient need skyrocketing, he also had to realize that they were capital constrained as a business. Furthermore, while ConsejoSano was one of the companies addressing the pandemic’s many negative effects, it too was dealing with the same challenges that all companies faced — moving to remote work and feeling socially isolated. Vik credits Abner Mason’s leadership for helping ConsejoSano make it through this period in a positive way, with a recent successful Series B raise that will allow them to build greater technology to support the services they are currently delivering.
• Challenges raising capital as an organization led by a black founder/CEO: Abner and Vik have made a decision not to hide their story and have become more public about their challenges in an effort to normalize discussions about fundraising with a leadership team of color. While Vik describes their own experience as a slog, he also wanted to highlight that it’s not all doom and gloom — there are great partners and people out there if you know where to look. During the period of late Q3 2020, Vik discussed candidly some of the challenges of growing without strong access to capital — having to make difficult decisions to bring the business in line, including downsizing in certain areas of the business. Had they had the capital they required, he believes they might have accelerated the progress they’ve made today. On the issue of raising capital as a diverse founder, Vik says that you have to be savvy enough to read between the lines at certain points. His learning from this is that entrepreneurship and venture capital are information and relationship businesses, and by networking with other founders, including himself if anyone is interested, you can understand which investors are good partners and which, candidly, are the ones to avoid. He very genuinely offered to chat with any listeners that want to learn more.

“There’s a mentality that money is the most important aspect of the ecosystem in the startup land, but I can tell you with certainty, it is not. There’s plenty of access to capital for good ideas, good teams, and solid business models.”

32:00 — End — Circulo and opportunities to innovate in the managed Medicaid space

• Health plan’s role in addressing barriers to care: Vik believes there is an opportunity in understanding how social determinants connect to outcomes. Until you understand this connection, you can’t build a care delivery system, or more broadly, an ecosystem that services a diverse population, especially one that has mistrust of the medical system. One of the principles that Vik intends to bring over to Circulo from ConsejoSano is that 100% of Americans are diverse. Vik recounts an example of the difference between an individual in Kansas as compared to one in West Virginia: they may look the same on the surface but are culturally distinct and may interact with the healthcare system in vastly different ways. Vik sees Circulo’s job as building strong relationships with members and providers to develop a new method of interaction that is both digital first and culturally relevant.

“There are real reasons why people mistrust [the medical system] that need to be addressed. There’s a lot of work to be done, and it can’t be done if we continue to operate in the fashion we are now where we don’t acknowledge, where we don’t articulate, where we don’t invite discussion, where we don’t survey the fears that are out there and address them with trusted information sources, or the right framing through and a technological pathway.”

• On the challenges building culturally personalized relationships with a digital-first solution: Vik first brings up Amazon to show that it is possible to build a reliable, usable, and personalized solution. Vik has seen an acceleration of the digital tools available, especially during the pandemic, and believes that the tools are out there for most populations and the secret sauce is in how you make populations aware of the services and how you tailor the experience of healthcare around the member. Vik recalls the experience of opening up his Uber app to see that he can actually have prescriptions delivered to his home through Uber. While this tool and so many others are great, he knew that there is still room to get better in terms of how to engage patients to use these tools. Vik sees the healthcare experience as having been optimized for the clinician instead of the patient and thinks we need to shift our framing to be more patient experience centric. Vik believes Circulo is best positioned to gather the right tools, at least partially as a result of their relationship with Olive, and to develop more nuanced relationships with their members as a result of his experiences with ConsejoSano.
• On the opportunity to address issues in managed Medicaid: ConsejoSano was an early entrant into this space, and Vik says that the issues with the consumer experiences in Medicaid were always there even though the funding may not have been. While it has always been the time to invest in managed Medicaid, Vik described three factors as to why Circulo will be able to hit the ground running in this space: the right talent is beginning to focus on these issues (e.g Sean Lane, Jeff Grahling, Sally Poblete, investor partners), there is greater national attention because of health inequities uncovered by the pandemic, and digital tools are becoming more readily available that will enable differentiated health delivery experiences.

“This is going to come across as crude, but it’s always been the right time to invest in managed Medicaid”

……..

We are so appreciative to Vik for joining us on this episode of The Pulse Podcast! Subscribe for our new releases on Twitter, Spotify or Apple podcasts.