The following interview is a conversation we had with Trenner Williams, Founder & CEO of Socially Determined, on our podcast Category Visionaries. You can view the full episode here: $34 Million Raised to Build the Social Risk Intelligence Category.
Trenor Williams
Bratt, thanks so much. I appreciate you having me. Not a problem.
Brett
Super excited for our conversation. So to kick things off, could we just sort a quick summary of who you are and a bit more about your background?
Trenor Williams
Sure. It’s interesting, I start out with my past profession. I’m a family practice physician by background and training, son of a social worker and a bar owner. So as I like to say, son of two social workers. As part of that, I live in Washington, DC with my wife and two girls who are almost ten and 14.
Brett
Tell us more about the bar, of all things. I have to zoom in on that first.
Trenor Williams
So I started working in a bar restaurant when I was twelve years old, busing tables for $10 a night plus tips. My dad managed the place for his best friend. It was a steakhouse that had a 16 ounce sirloin called the Ray Williams special. That was my dad. And the tagline was, it’s big and great, just like the man. And it was one of the coolest, still one of the coolest experiences to be a kid and certainly a twelve year old boy in an adult environment. It was the first of now 18 restaurants that I’ve ever worked at, which is pretty crazy. I still love the restaurant space and the bar space, how it brings people. Food brings people together, drink brings people together. It’s a wonderful thing.
Brett
Wow, that’s super cool. And what was it like being a doctor? What did you learn from that experience?
Trenor Williams
Everything. But actually, I would say I talk about it a lot. I learned actually how to be a better family practice physician by being a waiter and a bartender. Believe it or not, I still think of some of my introductions to my patients was just that ability to connect with somebody really quick. And there’s something special about being a physician, in my opinion. People close the door and I was family medicine, so most of the work that I did was in the outpatient ambulatory setting, and somebody would close the door behind them as they come in the room and open up and tell you everything about their life. And there are really very few situations where that type of intimacy happens so quickly.
Trenor Williams
And I still see that as a privilege and the opportunity to help be a navigator and a guide for the people that you have the opportunity to care for. I would say that it’s influenced significantly the work that I do today at socially determined how we think about the work and the connection to people every single day.
Brett
Now, in the back of your mind, as you were going through medical school and starting your career, did you have in the back of your mind that someday you were going to go and start a technology company, or where did that come from?
Trenor Williams
Absolutely no idea. So we had a fair amount of financial troubles growing up. My dad, who’s now passed, failed to pay the IRS for a few years, it turns out, which is part of the reason I went to work at twelve years old. And he was also doing sales and variable income. And I was like, there’s no way that I’m going to go into sales, no way I’m going to have a variable income. There’s no way I’m going to take risks. And when I finished high school and college in the early 90s, becoming a physician, honestly, is one of the least risky, most secure professions in America, and I loved it. My mom, again, is a social worker. She’s now retired, but worked with meals on wheels and the area agency on aging, and so really appreciated that.
Trenor Williams
And almost as soon as I got into residency, so this was 98 to one residency in Los Angeles, having gone to medical school in West Virginia, at Marshall, and undergrad at Virginia Tech, so East coast, smaller towns, Los Angeles was very different. 98 to one. The.com bubble had not burst yet. I had friends from Virginia Tech who had started a music based company, and for some reason, because I was in LA, I was doing business development with music executives during my free time, started a.com called Resonance Md. That failed in 2001 when the bubble burst as part of that. And that was my first sort of starting to take a little bit of risk, sort of insight into that. There was likely going to be something outside of the practice of medicine for me.
Brett
Super interesting. When it comes to your inspiration, who would you say is like, the most inspirational founder for you?
Trenor Williams
It’s interesting. It’s not like a big name at all. When I left full time practice in three, I still had the opportunity to practice part time till 2009. I was a physician in the Navy as a reservist. But I got out of full time practice, joined a consulting firm, and the founder was a gentleman named Ivo Nelson. And that was my first real formal introduction into a founder, into an entrepreneur. I learned in two and a half years, three years with Ivo. So much about business, about customer relationships, one of the things I still hold dear, he and the company had 100% client reference ability for over a decade.
Trenor Williams
And there was something special about sort of the work that you need to do to build those customer relationships, how you value those relationships, hold on to them, nurture them, and how important that was. And at the end of the day, if you do that right, you’ll figure out the money part. Makes a lot of sense.
Brett
I always appreciate when a founder comes on and talks about someone who’s not Elon Musk or Jeff Bezos. So appreciate you being original there with your most inspiring toner.
Trenor Williams
Yeah, of course.
Brett
What about books and the way we like to frame this? We got this from an author named Ryan Holiday. He calls him quickbooks. So a quickbook is a book that rocks you to your core. It really influences how you think about the world and how you approach life.
Trenor Williams
Do any quickbooks come to, you know, one that I think of? There’s an author named David Schipler, and he wrote a book called the Working Poor Invisible in America. I read it right before I launched this company, as I spent two years after selling my first company, nurturing the idea and trying to figure it out and read this book. And what we don’t appreciate, and what I certainly was just starting to appreciate was the massive challenge that everyday people across this country faced related to the barriers, obstacles, challenges in their life. And David writes about all the different unfortunate situations across an everyday person’s life that essentially take away what little discretionary income that they have. Right.
Trenor Williams
We think about a population who may have Medicaid as their primary insurance, and people are like, well, they’re not working, and so we’re providing a government based insurance for them. The vast majority of folks on Medicaid, not children who are on Medicaid, but the vast majority of adults on Medicaid, the vast majority work, but they struggle so much with meeting everyday needs of housing and food, car and transportation, and other things like that. And David does an amazing job of detailing all of those different challenges. And for me, it was a really helped to put a fine point on the challenge that as a company, that we wanted to go try to solve.
Brett
Well, let’s dive right into that. I think it’s a perfect segue. So, at a very high level, what does the company do?
Trenor Williams
I’m going to start. And, Brett, you are my TED talk. So this as my TED talk. If I had one slide and one visual to use, it would be a lot of the why we do the company. And it’s just two numbers. The first number is 63. The second number is 525,537. And it’s not some iteration of seasons of love from rent, but it is 63. So the average adult in the United States spends 63 minutes with a physician MP or physician assistant in an ambulatory setting in a given year, on average. So just over an hour, barely over an hour, which means they spend 525,537 minutes outside of that person’s care. And in the US, most of the decisions that we make about health care happen because of what goes on in those 63 minutes.
Trenor Williams
The diagnosis or condition that somebody has, where they’ve gone for care, the labs that they order, the medications that I might order as part of that. And we have been blind to the barriers, the obstacles, the challenge that happen in this 525,000 minutes. So it’s socially determined. We built analytic platform that allows us to characterize, quantify, visualize the 525,000 minutes. We use a combination of publicly available data from about 40 different public sources. We combine that with data about every single us business in the country.
Trenor Williams
So when I think about understanding healthcare access for you, like where you might live, knowing how close the closest pharmacy is, or federally qualified healthcare center or hospital or dialysis center matters, and when I think about things like food insecurity, knowing that there’s a convenience store that is snap eligible, that there’s a full service grocery store, how close that is, and how many fast food restaurants around people. So we combine that place business data with public data, and then identify data on about 270,000,000 adults across the United States. So, think of income. Do you own or rent a home, do you own a car? The language that you speak, et cetera, it’s about 800 different data elements there.
Trenor Williams
We take that public place and person level data, run it through algorithms that we developed and quantify food insecurity, housing instability, transportation risk, health literacy, financial strain at a person and at a community level. So think about that as understanding, again the risks that a person is facing in their everyday life. We partner with health plans, provider organizations, life science companies, and then we’ll combine that social risk data with their healthcare data. So disease condition cost data to better understand the impact of social risk on maybe a person or a population that has diabetes or heart failure as part of that, and then have analytic models on top of all of those risk scores that help identify the best resource intervention benefit to go mitigate those risks and drive better experience and outcomes at the person level.
Brett
Is that the pitch to the health systems then? Is it better patient experiences and better outcomes? Or what’s in it for the health systems to buy technology like this? It makes sense. Patient level. But what about from the business side? What’s the business case?
Trenor Williams
Yeah, and most of our customers are actually health plans. So it’s health systems who take financial risk, although still in the United States in 2023, I would argue most systems don’t take a ton of financial risk. But health plans do. Right. It’s the nature of their business. And in general, they are operating with incomplete data and making decisions that aren’t data informed about the investments that they can make around the people that they serve, the partners that they have. And so they do the best that they can. But again, they have not historically had this data asset. So, in a world where you have limited time, energy, money, and people, how do you make better decisions about those investments? So it starts first by understanding, and they think of folks as members. So at a member level, what’s risk distribution?
Trenor Williams
How many people have, again, food insecurity, housing instability, transportation is part of that. What’s the relationship to their cost and utilizations and where they’ve gone for care, the diseases that they have? And then how do I, if you think of a health plan as a hub, with all the different spokes that they have, the provider relationships that they might have, the clinical intervention partners that might help them address oncology or chronic kidney disease or diabetes, the intervention partners that they might have, like Uber health or a pix, who does social isolation?
Trenor Williams
We help identify those subcohorts of individuals that have specific risks that are driving poor outcomes, who need a specific intervention so that they, as the health plan, can engage those individuals in the right way, in the most efficient and effective way, ultimately, so that it drives down cost, improves member experiences, closes gaps on quality measures and heat of scores, and helps from a growth standpoint, whether that’s like Medicaid, new rfps, or commercial growth, getting new customers is part of that.
Brett
What’s it like selling into these health plans? Are they open to technology like this? Is it a hard sell and you’re just hunting for those early adopters? What’s that look like?
Trenor Williams
Brutal the average sales cycle was twelve to 15 months. I would say since the pandemic, it’s gotten even longer. And it’s not that people don’t want technology, but there’s the tyranny of the urgent. And just everybody is so focused on the day to day, it is hard to be able to pick your head up and think about what’s next. They also get bombarded by point solution after point solution at the end of the day. And so it is go back to my dad and go back to family practice. It’s about building relationships. I don’t think you win work with slick sales tactics. I think it’s about building partnerships over time and then ultimately being true to your word, being actually able to deliver.
Trenor Williams
Like the end of the day, if you say you’re going to do something, being able to actually do it, but it’s hard. It is a slog. Characterize a lot of it as like it’s a back alley brawl every single time. And it is not, especially in this space where you’re building a new market. It’s not for the faint of heart.
Brett
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Trenor Williams
What a great question. I am not involved in every sale. This year we turned over and really doubled down on a new sales team. Our two primary markets are payer and in that we are like payer provider. And then life science. We have new leaders. My life science leader is a year in. My payer leader is six months in. They’ve each got people underneath them now. And so I am much less involved. I still probably get involved in most deals. I still end up telling the story. What’s nice is I’m not running a lot of the commercial process in that sale, as opposed to, again, it’s more you up building than anything else.
Brett
What was it like making that transition out of sales? And the reason I ask is a lot of the founders that we have on the show, and just a lot of the founders I know in general, it’s something they really struggle with and they struggle to let go. And it’s just a hard couple of hires to make. So what did you learn from that transition?
Trenor Williams
Well, one is that you are likely if you don’t make any mistakes in hiring salespeople. One, I think you’re ridiculously lucky. And two, you may not be trying hard enough. I think it’s hard. So we’ve gone through different leaders and, like, unbelievably good people and well meaning, but either weren’t mature enough, we didn’t have enough resources around it. Market wasn’t right, their experience. So one thing that I learned is a, you’re going to make mistakes. Two is how do you continue to invest in creating the processes, the materials, the support for people that aren’t you as the founder? Because this is all I think about. It’s all I’ve been doing, like two years before I started the company. We’re seven years into this. There’s nobody that’s going to be able to tell the story in the same way.
Trenor Williams
And some of that is also like, you’ve got to learn to give it up. It’s not going to be the same. There are going to be parts that they’re going to do better than parts that they don’t. And you’ve got to get comfortable that’s okay. At the end of the day, something.
Brett
Else you mentioned there that I want to dive into is you mentioned creating a new market there. So from day one, did you go into this knowing that it was going to be a market creation play and that you were going to have to create a market and then create demand for the product? Or did you uncover that later on in the journey?
Trenor Williams
No, maybe I’m crazy, because, Brett, I knew it from the beginning. If you think about fall of 2016, it’s not that social determinants were a new thing. And again, my mom was a social worker. I think about public health people for decades, but it was really seen as not part of the business. It was part of what the foundation did. It was seen as a nonprofit responsibility. It was not integrated into the business operations and strategic decision making of systems or plans or life science or employers or whomever. And so maybe foolishly knew that were going to go create a market. And maybe the only foolish part, first of all, that part is amazing. The foolish part is, I think, believing that it might happen faster than maybe it has. How about that? We’ll take that.
Brett
And then for that market and for the category is it social risk intelligence or how do you think about the actual category that you’re in?
Trenor Williams
Yeah, well, I think broadly, because we spend a lot of time talking about the ecosystem of social risk and social, whether it’s social drivers of health. I think now that people are talking the non medical drivers, there’s all sorts of different nomenclature. I think we’re analytics first company, and I think of the analytics as core of what we do. And there are maybe a couple of companies that just do that. But there’s so many parts of this ecosystem. There are companies that are focused on referrals to community based provider organizations. They’re companies that are doing pure social interventions, again, rides social isolation, food insecurity delivery as part of it. They’re folks that are doing gap closure and engagement and navigation and using social risk and social drivers as part of that. And those are all, again, point solution around social risk.
Trenor Williams
So I see us as part of the broader social determinant, social risk ecosystem, and then analytics specifically is what we do. What’s been interesting is it creates this incredibly collaborative opportunity across that ecosystem, because we can be, and I don’t mean this in a pejorative way, but we can be the brains, but we have to have the arms and legs for our insights to be effective. So now, as we partner again with navigation, with referral companies, with intervention companies, with clinical companies around specific diseases or conditions, we can identify the subset, the cohorts of individuals who need those interventions, who need that support and drive the insights to them. We can make that whole ecosystem more efficient and better.
Brett
And what are you doing to educate the market and to create demand for this new market?
Trenor Williams
In addition to the 32 conferences that we’ll go out and speak at, half of those this year, just this year alone, that feels like a lot for a pretty small team. As part of that, we have invested, we think a lot about marketing and whether it’s LinkedIn marketing, direct pr as part of that. And part of that is getting, I would say, trying to get our customers and partners to be able to tell the story. I always have believed for the last, I guess, 20 years in this general business, if that’s who’s telling the story, it is going to resonate so much better with the market, with their peers. And so being able to do that, whether that’s at conferences, whether it’s directly with press releases and others, is part of that.
Brett
When it comes to conferences, how do you think about measuring ROI? That’s something else that I hear from founders. A lot is it’s very difficult to measure the Roi of events, and events can be very expensive. So how do you think about measuring that ROI?
Trenor Williams
I would love to know. It’s strict discipline around MQL creation and MQL to opportunity and opportunity to close one. And it’s not that we don’t try to do that, but it’s a lot harder than that and that can’t be the only measure as part of that. And I would not say that we have this figured out yet, but we’ve tried to become more disciplined as we think. Like, again, 32 conferences that we’re going to end up at, we know that some of them are purely just about eminence and being there as part of that. We know that some of them are going to be about building our partner ecosystem, that it’s unlikely that we’re going to get a significant amount of customer leads as part of that.
Trenor Williams
And then there are others that we are really explicit, like what do we do ahead of time meetings to set up driving to very specific, targeted leads that we believe are going to turn into opportunities? I would say this year in 2023 is by far the best year in doing that. It’s been such a weird few years with COVID and also feels like there are more conferences than ever before. I still think trying to figure out the ones that the vendor to customer ratio isn’t ten vendors to every one customer. So trying to figure out, we found a few that are closer to two to one to one, and trying to maximize those.
Brett
Can you give us an idea of the type of growth that you’re seeing today?
Trenor Williams
Yeah, so we think a lot like pure analytics, no services, we have a customer success team. And so one of our biggest metrics and we’re doing three year deals is contracted ARR as one of the biggest drivers for us. And I think year is not over, but it looks like we’re going to be, I think, 68% to 70% contracted ARR growth year over year, which is a big deal for us. I would love for it to continue to be a little bit higher and grow as part of that. I think we’ve got the opportunity. I think next year will be bigger, I think we will be 90% to 100% next year, but really happy with, in a hard healthcare, economic environment, with health systems in the worst position they’ve been at in 50 years. And most health plans, right.
Trenor Williams
If you looked at August, September, October, most health plan, major health plans did pretty big rifts, right, with their stats as part of that. And we’re still gaining net new customers throughout the third and the fourth quarter, so feel pretty good.
Brett
What do you attribute to that growth and that success? I think any founder that’s listening in wants to be able to answer that question in that way. What have you gotten? Right.
Trenor Williams
I think the sales piece that I talked about before, like the investment in top of funnel. And so we’re having more meaningful conversations this year than we’ve ever had before. And a lot of that is me letting go the reins. It’s not all founder driven and so a team that’s there. But I would say the biggest thing is we had over the last twelve months, probably the most existing customer maturity than we’ve ever had before. And some of that is just like again in a new market, people, even our customers who paid for this, are still figuring out how to drive value. And as much as we’re trying to help, we can’t and shouldn’t do everything for them. And so one of our best and longest term customers, we have all 3.2 million members that this health plan has.
Trenor Williams
And went from working with 160,000 of their members and one team to now 3.2 million members and 14 different teams. Utilize our analytics and part of what were able to do this year that I fundamentally think has changed the conversations, is we’ve been able to turn that story and a number of others that are like that, make it real for the net, new customers, the pipeline folks that we’re talking to. Because I think in healthcare, most people are risk averse, most people don’t want to go first. And so hearing and seeing what their peers who look like them, act like them, have businesses like them are doing, has probably been the biggest thing that turned the opportunity for us.
Brett
As I mentioned there in the intro, you’ve raised about 34 million to date. What have you learned about fundraising throughout this journey?
Trenor Williams
You still get nine no’s plus to everyone. Yes, that you get. And it’s a humbling. Fundraising is a humbling experience. And part of it is learning. My daughters, I have a Taylor Swift bracelet now that says move past the no, that isn’t, I guess, from a Taylor Swift song, but it was inspired all the bracelets that I have from them on that. And it’s like you’re going to get so many more no’s and you’re going to get yeses. And finding for us it was really important. We had a lot of early strategic investors who also became customers or were customers and then became investors, depending on. And that was really important, because when stuff gets hard, having somebody that has aligned incentives to help you grow was really important.
Trenor Williams
And then as we started to do bigger rounds, we only talked to and only wanted to talk to people who were dedicated healthcare investors because they just understood the space. And I think for us, and that’s not the case necessarily for everybody out there, but for us, that was really important.
Brett
Final couple of questions here for you. Let’s imagine you were starting the company again today from scratch. What would be the number one piece of advice you’d give yourself?
Trenor Williams
I would invest earlier in getting faster customer adoption, to try more things out at lower cost, just to test the market and worry less about any early revenue and more about established use cases and valued propositions as fast as we could. This is going to seem silly, but I think you invest as a company in general, and I don’t think this is just this company infrastructure and operations less than you always do it later than you probably should, and then you want to. And I kept saying this time is my second time around, that I was going to do it faster. You still didn’t. You make different choices as part of that. So if I get to do it a third time, I will try to do that. I will try to do that earlier.
Brett
Final question, Toria, let’s zoom out three to five years into the future. What’s the big picture vision that you’re building?
Trenor Williams
So I see us as starting to acquire some of those different point solutions across the ecosystem. I think when you think about, especially on the health plan side where they are trying to go, if we can be a one stop shop and start to solve significant number of problems and have solutions in house and take on increasing amount of responsibility and share of dollar as part of that, I think everybody wins in that model as part of that. Number one. Number two is I see because of, even as a small seven year old company, our ability to work in payer, provider, life science and employer, right. You think that is the money at healthcare? We have a really interesting opportunity to be at the nexus for that ecosystem. And because, Brett, the people that we’re talking about are the same.
Trenor Williams
So a provider thinks of them as a patient and a health plan thinks of them as a member and a life science as a clinical trial practitioner, somebody who takes their drug and employer as an employee, it’s the same people. And so if we have an opportunity to come together and get more value from each of those different ecosystem partners, we might actually change the way healthcare gets delivered and received in this country. Amazing.
Brett
I love the vision. We are up on time, so we’ll have to wrap here before we do. If there’s any founders that are listening in and they just want to follow along with your company building journey, where should they go?
Trenor Williams
So sociallydetermined.com as part of that. So LinkedIn, Twitter and other. It’s socially determined. Nice. And is it? Is what we. It’s a. The name makes sense, but would love to hear from folks and what their journey is as well.
Brett
And what about the bar? We have to give the bar a shout out.
Trenor Williams
I wish the bar still existed. The best of my dad. And there were a bunch of them, so one of them was Blueberry Hill, which I’m going to date myself as part of that and date my dad was amazing that played 50s music and 60s music, but my favorite one was the tiki room back in the day was great. Hardcore tiki drinks. Yeah, that I probably had too many of. Brett, that’s awesome.
Brett
All right, man. Thank you so much for taking the time to chat. This has been a lot of fun.
Trenor Williams
Thank you, Bratt.
Brett
All right, keep in touch. This episode of category Visionaries is brought to you by Front Lines Media, Silicon Valley’s leading podcast production studio. If you’re a B2B founder looking for help launching and growing your own podcast, visit Frontlines.io podcast. And for the latest episode, search for Category Visionaries on your podcast. Best platform of choice. Thanks for listening, and we’ll catch you on the next episode.
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