The following interview is a conversation we had with Amar Kendale, President & Co-Founder of Homeward, on our podcast Category Visionaries. You can view the full episode here: $70 Million Raised to Transform Rural Healthcare Through Technology
Brett
Hey, everyone, and welcome back to Category Visionaries. Today we’re speaking with Amar Kendall, Co-Founder and president of Homeward, a healthcare technology company that’s raised over 70 million in funding. Amar, how are you?
Amar Kendale
I’m doing really well. It’s great to be here with you, Brett.
Brett
Amazing. Super excited to have you. So, on your LinkedIn, I see that you’ve spent the last two decades building products and technology that shape the future of health and improve lives. So I want to start there. Where did that mission statement come from for you
Amar Kendale
So our experience at Homeward, at its inception for myself and my business partner and Co-Founder, Dr. Jenny Schneider, really arose in our prior experience together when were with a company called Livongo Health. And at Livongo, were delivering services for people with chronic conditions, things like diabetes and hypertension, and our services offered nationwide, typically through employers. So we’re reaching a very broad swath of people. But one thing we observed that was very interesting was that were having an outsized impact on rural employees. So folks who are in rural Maine, for example, or really, frankly, you name it, every state in the US has a rural area. And so for those individuals, what were hearing back from them was that. This was a lifeline. The ability to use technology to connect them to care resources is something that.
Amar Kendale
They’D never experienced before. And because of the logistical challenges of.
Amar Kendale
Living far away from care, this was really making a difference. So, you know, that seed was planted back in those days. And when Jenny and I were starting to scope out where we wanted to spend the next decade plus of our lives, were looking for a few things. We were looking for a place we.
Amar Kendale
Could have real meaningful impact, a place where there were health disparities or outcomes that just needed to better than they were. We were looking for places where we could align the business model with the.
Amar Kendale
Needs of the population. So that brought us to value based care as the. As the concept we wanted to be embracing as the basis for what were doing and third, places where technology was not.
Amar Kendale
Just a nice to have, but really critical in order for any kind of solution to work. And we found all of that in rural America. We found these massive health disparities. We’re talking about 23% higher mortality for rural Americans relative to their urban and suburban counterparts. When you start to peel back the onion and look to figure out why part of it’s explained by the fact.
Amar Kendale
That you have only half as many doctors, primary care doctors, you have an eighth as many specialists, you have 700 hospitals that are due to.
Amar Kendale
Close, that are at the risk of closing. And so the nature of the problem here and sort of why we’re seeing. What we’re seeing, you can start to.
Amar Kendale
Get a handle on, okay, there’s a real resource shortage and then that brings us to this.
Amar Kendale
Aspect of technology, which is if this resource shortage is there, we’re not going to fill this by trying to persuade more doctors to move to rural areas. There’s no way to solve the solution.
Amar Kendale
In a brute force kind of way. So technology is going to be an.
Amar Kendale
Essential part of what we need to bring to rural America in order to turn things around.
Brett
So you decided to pursue this problem and build a solution here. What other opportunities were you considering that you ended up not going with?
Amar Kendale
Yeah, well, I mean, you know, the good news, I guess, in healthcare is there’s no shortage of problems and no shortage of big problems.
Amar Kendale
You know, we were also very passionate, I think, about opportunities to see how specialty care can really extend its reach.
Amar Kendale
And, you know, it’s a bit of an artifact that we have specialists attached to hospitals or health systems. The majority of the work they do is non procedural. You know, 60% of the work is non procedural. So there’s a lot of reasons for why that’s become ossified in the healthcare system, billing being one of them.
Amar Kendale
The way that hospitals generate revenue with the way they collect, you kind of collect proceeds. But when it comes down to the nature of the work, the ideal is a world where we could untether our specialists from a physical site and make. Their capacity available more broadly.
Amar Kendale
So our thought was, is this the moment when specialty care can start to. Get virtualized and distributed more freely across.
Amar Kendale
The areas of need? Similarly, were interested in doing this in a value based care kind of construct and we have some great examples in.
Amar Kendale
Kidney care where this is beginning to happen. We’re not moving quite as fast in other clinical areas. And so that’s something I think that we continue to watch and are still very excited to see.
Amar Kendale
And I think at home we’re going to have a chance to participate in somewhat as well. We’re very interested in the way that value based care is showing up in pharmacy, pharmaceuticals. I mean, the punchline is it’s really not, by and large, there isn’t much in the way of outcomes based pricing.
Amar Kendale
When it comes to pharmaceuticals. And so that was an area were very interested in exploring because it really ought to be the case that you know, that high cost medications are.
Amar Kendale
Really attached to Delivering better outcomes for patients as opposed to other, you know, artifacts that are driving the way they’re priced. So another area I think of a lot of interest, you know, the amount of spend that goes into pharmacy pharmaceuticals is rising. And so it is an area of opportunity. And particularly in a world where we could align incentives, that’s something exciting to us. And then we have these other more general trends that we find to be.
Amar Kendale
Really fascinating around value based care and the way it works in today’s market most of that value based care work.
Amar Kendale
Has been centered on primary care. But what about a world where every.
Amar Kendale
Participant in the value chain for delivering healthcare services could sign up for delivering outcomes? What if there were a way for us to distribute the load so it doesn’t all sit on primary care, but.
Amar Kendale
Instead we had mechanisms to propagate that delegation of risk across the entire ecosystem. It would start to create some really interesting phenomena and eliminate a lot of the distortion that we have in healthcare. This is one of the most perversely distorted markets that exists in America for a lot of reasons. But if we could start to straighten.
Amar Kendale
Out some of that with more clear incentives, we think that there’s some profound impact to be had. Another thing that I think at homeward we see our opportunity as we’re building this business and service for rural Americans, at least we see an opportunity to deliver some of these capabilities to that.
Brett
Group of people when we look at value based care. I’m not in the healthcare industry. Whenever I hear people talk about it, I think, yeah, great, that sounds awesome. It seems like a no brainer, but I understand it’s more complicated than that. If there’s critics out there, which I’m sure there are, a value based care, what is their criticism of it? Do they say it just doesn’t work, it can’t work? What are those critics saying? It’s a great question. So value based care, I think has.
Amar Kendale
Really been growing in its presence, certainly accelerated over the last 10 years since the Affordable Care Act. That’s really when things started to gather momentum. And you know, initially I’d say there was, you know, just critics more generally of that entire set of policies. You know, there was obviously a lot of divide around how we go about changing the way that care is delivered and paid for. I think in more recent years, now that we’ve seen a couple of full cycles of value based care in the.
Amar Kendale
Market, we’ve seen what’s working well and what’s working isn’t, I’d say the most kind of Articulate critics have shaped an argument focused on all of the ways that the incentives can be perverted and used to ill effect. So one example is a concept called risk adjustment. And the way this works is a population has some amount of disease burden, people are sick and it used to be the case that providers get paid for those sick people, whether they’re, you know, the amount of influence of their complexity on how much Friday gets paid is pretty limited and it’s more tied to how much time, you know, that’s the kind of dominant factors how much time the provider spending. So utilization based model of reimbursement in value based care, the idea is that it, that the reimbursement should be based on the complexity of the patient.
Amar Kendale
So suddenly it created a lot of motivation to go find complexity. And so, you know, as with any incentivized behavior now you have lots of people looking to see, oh well, is this, you know, maybe there’s more disease here and I should be looking for it in some cases it’s led to abuse.
Amar Kendale
Of that system and folks, you know, documenting disease that isn’t even there, or probably more typically documenting disease but then not really doing anything about it. And so I think those are some rightful critiques of the way that, you.
Amar Kendale
Know, value based care has been working to date. I think, you know, we’re seeing some appropriate tightening up of the.
Amar Kendale
Regulations around this, particularly in terms of how, you know, disease burden should be captured and coded and reported.
Amar Kendale
So there’s some, you know, as with anything, there’s improvements that only can really.
Amar Kendale
Show up once you had a full cycle of experience. I think the other piece of this is, you know, how do you keep that sort of transactional mentality out of. Value based care where someone’s just focused on that front end and capturing all.
Amar Kendale
The, the codes and then walking away. I’d say that’s been very central to our approach at Homeward is to say.
Amar Kendale
That’S not real value based care. You know, that’s not real responsibility and long term partnership with our patients and with their providers and with the payers. That’s only going to come from not. Only understanding what the burden of illness.
Amar Kendale
Is, but doing something about it and making sure that something happens that’s going to, you know, bend the arc of the outcomes. In a lot of cases it means, you know, for example, you find a person maybe hasn’t been diagnosed with high cholesterol or high blood pressure. The onus should be on all of us in value based care when we identify those things to immediately act to help to get that patient under good medical management and ideally those conditions under control. So that follow through really has to be there. And I’d say that’s something that we’re very focused on at Homeward. And I believe that we as a healthcare ecosystem can construct those incentives to work like that. It’s not the default.
Amar Kendale
And I think that’s where it takes some longer term commitment in order to really see those things happen.
Brett
So you have this idea, you say, I’m going to spend the next decade plus solving this problem building this company. What happened from there? What did the first, let’s say maybe three to six months look like?
Amar Kendale
Oh, well, you know, went on to rapidly make a series of mistakes. You know, as no Founder can say that, yeah, if you’re doing your job, you know, you’re, you’re learning as fast as you can. And so, you know, I’ll share one anecdote about this, you know, because our intent there was to make, you know, kind of our mistakes quickly, you know, when they were of the least consequence. And in a world where we could rapidly iterate and find our footing, you know, one of the things I think we did right was we got into market quickly and we started seeing patients quickly and offering services quickly. And we felt very comfortable with this because this is a world where capacity is so short. You know, it’s less, I think, less. Straightforward when you’re entering a crowded market.
Amar Kendale
Right, to say, hey, we’re going to be another, you know, doctor in a crowded market. Instead, we’re going to this place where there aren’t enough doctors. So we felt it was a balanced. Risk to say, we’re going to go in and just start seeing patients and delivering care.
Amar Kendale
And, and we’re going to do it. In the interest of the patient, try.
Amar Kendale
To really elevate outcomes. Our initial take was as we looked at the data, what we saw was bearing out what I shared with you.
Amar Kendale
Earlier, Brett, which is there’s about half as many primary care doctors. The way that was showing up for our patient panel was that about a third of people hadn’t seen a doctor in over two years. Now, an interpretation of this would be to say, okay, well, those are people who probably need a doctor. So let’s come out, we’ll hang up our shingle. Homeward is here. Come, you know, we’ll be your doctor, we’ll be your primary care doctor. We can come see you in your home, you can see us in our mobile Clinic, you can see us in one of our pop up clinics. So went out with that message and we struggled, candidly, we struggled to bring patients on. Bring patients on. And as we found there were some. Patients who tried our service and loved.
Amar Kendale
It and became kind of loyal and ardent supporters. You know, they were getting exactly what they’re hoping for was, you know, lots of time with their clinicians and really great considerate care. But others said, you know, I’m just not interested. And we asked them why and they.
Amar Kendale
Said, well, I have a doctor. And then we said, wait a second though, you haven’t seen anyone in years. Well, they said, yeah, you know, I’m not dying, I’m not bleeding, I don’t have any broken bones, you know, so I’m, you know, I’m an independent person and if I really am in trouble, that’s when I’ll see my doctor. And we said, oh, well, that’s interesting. That means what’s different about the way people are consuming health care in rural.
Amar Kendale
Is the thing we have to pay attention to. It’s not simply that there’s not enough doctors, but it’s what are those doctors. Spending time on and how are those.
Amar Kendale
Patients interacting with their doctors? And so what we found was it’s actually. More nuanced. And it turns out that patients are.
Amar Kendale
Getting from their doctors acute care. So when they’re in trouble, they go to their doctor. They get the care they need in.
Amar Kendale
That moment for something that’s a big problem. What it means for those doctors is that their days are full with very sick people. And so what’s not happening is all the things that ought to be happening kind of in between those really complex events, those really sort of bad circumstances. And that’s things like making sure you’re getting your colonoscopy and getting your blood pressure checked and managing your diabetes. Those are all things that are kind of longer term. They’re necessary, but they’re not acute.
Amar Kendale
They’re not like bothersome on a daily basis for most patients. And by the way, most doctors don’t. Have the staff and resources to be.
Amar Kendale
Doing the outbound, you know, calling patients to say, hey, it’s time for this or that or the other thing. And they don’t have time in their day to see patients who don’t have these acute issues. You know, they’re already working, you know, long hours to care for their panels. So, you know, that shape of the problem was different than what we initially thought. And so, you know, within a Few. Months, you know your point?
Amar Kendale
Three to six months. We really got our arms around this and recognized that our role to play was something different. It wasn’t to be the primary care doctor, the only primary care doctor a.
Amar Kendale
Person had, but it was instead to. Figure out what are the primary care.
Amar Kendale
Services that are missing in the market because of the shortage of capacity you mentioned there.
Brett
Getting to market quickly, that’s not something I hear very commonly when I’m interviewing healthcare technology founders. What was the key to getting to market quickly?
Amar Kendale
Well, you know, it wasn’t.It was, I think, by deliberately deciding.
Amar Kendale
That weren’t going to start by building technology, I think there’s a trap, you know, a lot of technologists fall into, and I’ve fallen into it many.
Amar Kendale
Times in my career, which is that. You have a vision for the way.
Amar Kendale
That technology can play a role, and you decide to start building and start building first before you really know whether it’s exactly the right problem or not. And then you build something and you. Take it to market.
Amar Kendale
And now you’re a little bit in love with your idea. And so when the negative signal starts to come in, you know, you might resist it, you might reject it. Early on, we took the opposite approach. We said, we’re going to build as little technology as we need just to.
Amar Kendale
Get started, and then we’re going to be very responsive. So we built our tech team on. Day one, and they were ready and they were there learning alongside our clinicians.
Amar Kendale
You know, they were embedded in, like. The workflows and understand kind of what.
Amar Kendale
Was happening in a visit. You know, they were standing off some of the rough edges in the experience.
Amar Kendale
And making sure that things went smoothly in the course of a typical, you know, onboarding and so forth. But weren’t building, like, heavyweight technology at that time. And it wasn’t until really our second year that we felt a lot of conviction that we had the service oriented.
Amar Kendale
Right, that we knew what kinds of outcomes and metrics were going to aim at, and we really could build with conviction. And so when we started doing that. We were able to ship a lot of those services.
Amar Kendale
And the places in a business like. Ours where there’s a lot of clinical.
Amar Kendale
Operations, most of what you want to do is figure out places where you can streamline workflows. And so that’s something, I think there’s just no way around running the workflows yourself. No matter how much you kind of whiteboard it or strategize, you’re going to be wrong. There’s this. I’m going to misquote something here, but I kind of live by it. You know, no strategy survives contact with the battlefield. I think that’s absolutely the case, you know, in a world like this where it’s a highly complex, highly operationally oriented type of business. And so that was, I think, one of the things that it took some forbearance on our part to not jump in and start building things, because, you know, Jenny and I have no shortage of ideas that we’re excited about in terms of tech we could build.
Amar Kendale
But I think it was the right call and I think it’s really served us well to continue to take that approach. Even as we’re making strides in growing the population and growing the services we offer, we try to launch it first in a sort of more manual and operational way and use that as a basis to decide where the technology investment is going to make the biggest impact.
Brett
Have you always had that product philosophy or in other times in your career, did you have trouble where you overbuilt the technology that it ended up people didn’t want?
Amar Kendale
Yeah, I’d say, like the first half of my career is like a litany of, you know, technologies I fell in love with that were a struggle to bring to market, you know, and often this is the case with technology push. You know, where there’s a technology, you.
Amar Kendale
Know, it’s a hammer looking for a nail. And so, you know, there were. There were cases in my prior life where, you know, perhaps there was an enabling capability, you know, something like, you. Know, I was working for a period.
Amar Kendale
Of time on stretchable electronics and, you know, what an incredible idea, right? Electronics that have the same kind of.
Amar Kendale
Properties as human tissue and human skin. And like, there’s unlimited possibilities. That’s the problem. There’s unlimited possibilities. And so knowing which one to go.
Amar Kendale
After and to really go deep on, you know, becomes the heart of the challenge. You know, even when the technology is incredibly capable, you know, it has enormous potential. And so, you know, so that the risk there is, you start to boil the ocean and you never do get. To the one killer app or the.
Amar Kendale
You know, the thing that really would have made the difference, you may never get to it. If you, if you start with a very broad technology approach, you know, we’re watching a little bit of this right now with generative AI, where it’s an. Extremely, you know, these large language models, extremely powerful technology.
Amar Kendale
And, you know, we’re watching a kind of generation of companies getting started saying, we’re going to be the gen AI company for healthcare. And, and you know, I’m hopeful that they land on use cases. Quickly because that’s really what it comes.
Amar Kendale
Down to is, you know, they’re sort of racing the clock between what the technology’s capabilities are and what the market needs today. And the market’s not going to wait. You know, it might be the case. That a lower tech solution can come.
Amar Kendale
Along and actually solve the problem. I think it’s one of the unique. Benefits here at Homeward in that we.
Amar Kendale
Have both the care delivery arm of what we do, the people, the front lines. You know, we’re on the front lines delivering care ourselves.
Amar Kendale
And we have the technology team that’s using generative AI and getting deep into like the strengths and weaknesses of this set of technologies, you know, what’s it.
Amar Kendale
Really good for and what’s it not so good for. And so we’re able to decide, you know, where and how to apply it kind of within our own four walls as opposed to relying on vendors and hoping they get it right for us or, you know, kind of throwing it over the fence to other providers and.
Amar Kendale
Hoping that they know how to use it. So we kind of, you know, in a sense are sitting across both of those ourselves.
Brett
So I think that helps us understand the approach to product and technology. What about the approach to marketing? How would you summarize your approach to marketing healthcare technology?
Amar Kendale
Well, so I think that healthcare is ultimately a, an industry that rests on trust. And historically it’s been a very local industry. You know, historically people have consumed their healthcare locally. The brands that they’ve historically trusted are their local health system, hospital, you know, maybe their primary care doctor, family practice. And it’s only recently that we are.
Amar Kendale
Seeing the emergence of brands, you know, certainly at the national level that are trying to engender trust to varying degrees of success. And you know, in the. Challenged or negative column, you have health.
Amar Kendale
Plans, you know, which have, generally speaking, a negative net promoter score, very low levels of trust. You have health systems that are working at a larger scale these days as.
Amar Kendale
They’Re getting consolidated and aggregating. And so as they become more and more national, you see, you know, higher. Net promoter scores, but lower than they.
Amar Kendale
Used to be, you know, as is natural. Right. With that kind of phenomenon. And I think for Homeward, you know, we’re really trying to take advantage of these phenomena and kind of observe which lessons are the ones that we should apply in what we do. When were building services At Livongo focused on chronic conditions, we enjoyed a very high net promoter score because were solving very specific problems on behalf of our members, and were interacting.
Amar Kendale
With them on a very personal level. So, you know, our team of, at that time, it was certified diabetes educators. It was, you know, our Livongo front desk staff. And it was our devices that were putting in people’s hands that created that opportunity to create trust. At Homeward, it’s a little bit different, but the part that’s the same is. We rely on our frontline staff a great deal for building trust, and those.
Amar Kendale
Are folks we hire locally. So in the rural counties that we’re.
Amar Kendale
Serving, we build our team on the. Ground that is directly interfacing with patients.
Amar Kendale
Now, it’s not the doctors typically that we’re talking about. We’re talking oftentimes about our team of medical assistants, our community health workers. They’re our frontline, and they come from these communities, so they understand them really well.
Amar Kendale
They have a really high degree of cultural competency. They are ambassadors for the Homeward brand, which is a new brand and one we have to introduce and gently educate people on. Here’s who we are, and here’s why we’re here, and here’s what we aim to do. But we have those ambassadors, you know, who can help us to spread that message. And then the other part of building trust is delivering on what we promise. And that, I think, is a lot of what technology can do in a pretty unique way, where with traditional operations, you can have a lot of variability. Maybe, you know, you end up with. A long wait time on the phone.
Amar Kendale
You know, that’s one of, like, the most notorious, you know, things that shows up and how long, you know, can we make you wait on the phone to get your. Your healthcare approval, prior authorization, or whatever it might be that you need from your health plan. Answer is people wait hours for that, and it’s a terrible experience, and it’s a place that erodes trust. So that’s a great opportunity for us to use automation and use technology to make a lot of those hassles go away. And if we can do that, then we can really start to create trust around the brand. The experience of Homeward is one where.
Amar Kendale
You can expect us to be responsive. And efficient and value your time and be consistent.
Amar Kendale
You know, it shows up the same way every time you use us. So that’s the complimentary part to the things that we do, you know, in the market, on the ground. I think what it’s meant for us. Is I think we’re really finding our way to establishing our own presence homeward.
Amar Kendale
Here’s who homeward is, here’s what we do, and here’s how we show up. And then the last thing I’ll say is a lot of our go to market comes from partnership. And it’s sort of that, you know. In any given market, we’re partnering with at least two entities around a given patient.
Amar Kendale
We’re partnering with their health plan. That’s who we enter with, and that’s kind of who we’re directly allied with. And we make every effort to partner with their provider. And so we’ve been very successful now.
Amar Kendale
In our first markets at creating structural. Relationships with the top health systems.
Amar Kendale
And it’s been a phenomenally rewarding experience for us to go do this. I think it really is a byproduct of learning, in some ways, learning the hard way, that our role in the. Market is to supplement the existing provider.
Amar Kendale
Not to displace them and not to create abrasion or confusion for the patient. And so as we’ve gone about doing this, we’ve been able to build those bridges with providers and actually arrive at a place where they’re eager to work with us. They actually look at us as a supporting kind of element in their ecosystem. And so now here’s home word. And we can say things like, we.
Amar Kendale
Work with your doctor because we do. We have a relationship with your existing. Doctor, and we coordinate care with them.
Amar Kendale
And we help them do their job better and rework with your payer. And so those are the ways that we’ve been able to situate ourselves and. Introduce ourselves and grow, frankly, very quickly.
Amar Kendale
In a market that’s traditionally not accustomed to accepting new entrants and kind of growing at the pace that we’re growing.
Brett
That’s a perfect segue to ask about growth. Are there any metrics or numbers that you can share just to tease us and tease the audience?
Amar Kendale
Sure. You know, so I’ll maybe start with what we. What we. What we always start with, which is, you know, do our members love us? And so, you know, our kind of headline, you know, our headline is an 80, a score of 80 on our NPS, you know, which is, frankly, you know, better than we ever did, you know, at Livong or any other place we’ve been. This is true for Jenny and me. So it’s an extraordinary score. I think it reflects both, you know. The way that our care teams and.
Amar Kendale
Our tech teams have built and delivered what they deliver it also speaks to the need and I think the depth. Of need that exists in our market.
Amar Kendale
And how grateful patients are when we’re able to offer them the kinds of services that we do. So I think it’s some of both.
Amar Kendale
That contributes to that net promoter score. I think the other metrics that really. Matter to us are do we have.
Amar Kendale
The reach and impact that we’re hoping to? Are we actually caring for as many people? So that’s been a very rapid curve. And you know, I won’t give specific numbers in terms of the number of members we have, but I will say that, you know, compared to our predecessors, other value based care companies, you know, we’re, I think we’re growing at a rate that’s probably double the rate that they grew at, you know, at a similar age. And so, you know, in part that’s. Us standing on their shoulders.
Amar Kendale
You know, they’ve done a lot of the hard work for us. And I look at the Oak. Streets and the village MDs and the.
Amar Kendale
Agilens as companies we hold in extremely high regard and have learned a great deal from. Because of those things, I think we’ve. Been able to enter the market and.
Amar Kendale
Grow at a more rapid pace. Still very cautious. And it’s responsible growth. Of course we don’t want to, it’s not growth. This is not the zero interest days anymore. So we grow very deliberately. But the demand is there in our.
Amar Kendale
Market and rural America. I think while it’s been kind of a poster child as a bipartisan issue for a long time, I think we’re. Reaching a moment now in the market.
Amar Kendale
Where health plans really appreciate why it’s important to strengthen their rural provider networks. And providers are open to help in a way that’s new. And so the demand is there.
Amar Kendale
And I think that also is reflected in our rate of growth. So we’re roughly tripling to quadrupling the business every year. And we are on a very strong trajectory there with ample demand looking forward. And then finally, I think the next thing that matters is once we have the scale pieces figured out, are we delivering on our promise of clinical quality and outcomes? That’s where we’re also seeing really strong early data. And one of the places we focus on, for example, is gaps in care. This reflects where are there things that.
Amar Kendale
Are clinically known to be necessary for our patients? What are they actually getting? Can we bridge that gap? We focus a lot of our effort.
Amar Kendale
On understanding how big those gaps are and then pointing our teams at helping.To close those gaps.
Amar Kendale
That’s another place where we’re seeing really strong results, early results now, and I think is another part of the foundation that we’re building on.
Brett
As you reflect on this journey, what do you think has been the most important go to market decision you’ve made and take us behind the scenes. How did you make that decision?
Amar Kendale
Oh, wow, that’s a good one. And this is another one where, you know, if you ask me this question in five years, Brett, I think I’ll have some really wonderful kind of revisionist history to say how this is all, you know, so carefully plotted from day one. I think, you know, I think to be honest, the strategic decision is probably the one I alluded to earlier, which is coming in with a lot of humility and knowing that we don’t know the answers and knowing that we’re going to learn very fast and be wrong a lot. I think doing that before the stakes.Are so high that they could kill.
Amar Kendale
The business, you know, is probably the most important thing we did, you know, as were, as we’re growing homeward. I think that, you know, were fortunate in our selection of markets. And I think that’s an example where we had some strategic intuition and then subsequent work really kind of ratified that for us. So, for example, the two markets we entered early on were Michigan and Minnesota. And we came in with a focus on Medicare and specifically Medicare Advantage as the population that we would serve to begin, as I mentioned, at the very.Beginning, there’s rural communities all across America.
Amar Kendale
Every One of the 50 states has.Rural communities in them.
Amar Kendale
But Michigan and Minnesota have a large proportion of Medicare beneficiaries and a large absolute number of Medicare beneficiaries. So as far as markets to go into, because there are a lot of factors in starting up a new practice or care delivery arm that are kind of happen at the state level. And so you could easily die by a thousand cuts if you go after too small a market, you pick, you know, Delaware to start. Right.
Amar Kendale
Probably not enough headroom given the cost of standing up the market. But we chose markets that really have given us a lot of headroom. And it’s both because the Medicare populations are large, the Medicare rural populations are large, and because the partners that we’ve chosen to work with share our vision for what rural healthcare can be. And so I think those areas where we had a strategic hunch and then our time in the market really proved to us that we’d made some good decisions. And now that’s become, I think, a template for us and Part of our playbook. I think we know what attributes we’re.
Amar Kendale
Looking for now as we consider the markets that we’ll be adding as we grow.
Brett
What about lessons learned from fundraising? So as I mentioned there in the intro, over 70 million raised to date. What have you learned about fundraising this time around?
Amar Kendale
So, you know, the kind of business we’re in is very capital intensive. This is not a place where you can run, you know, lean startup or I mean, I think some of those sort of SaaS oriented financing techniques, you know, factoring or you know, customer LED financing, those sorts of things are challenging in an area like this in healthcare where we’re doing care delivery, you know, we are a provider in the way we operate, we’re doing value based care and we’re a technology company, all those things. So I think our most important decision at the very outset was choosing our investor partner. And that was actually a pretty easy decision for us. It was General Catalyst and specifically Heman Taneja at General Catalyst.
Amar Kendale
Heman, someone that I’ve known for well over two decades, but Jenny’s also gotten to know very well during our time at Livongo where Hemant was the earliest investor, the earliest kind of institutional investor at Livongo, really a co founding investor there. And so we really wanted Hema to be our co founding investor at Homeward. And in part because he thinks as big as we do, you know, he thinks bigger than we do and pushes us in fact to think bigger. And so that became a very natural partnership right at our inception. In fact, I think we may have. Somewhere in the archives, you know, the.
Amar Kendale
Napkin sketch that Jenny and I did that we brought to Hemant’s back patio as were shaping the initial trajectory of Homeward and what kind of business we thought this would be. And were kind of, were sheepishly sketching out the path to being a billion dollar business. And heman added the zero. He said this is easily a $10 billion business. And so that’s what we’re going to go build together. And so I think that initial choice was a really important one for us. General Catalyst has been a supporter, certainly our first backer. They led our seed round, they led.
Amar Kendale
Our Series A and then we brought on like minded investors in our Series B as well. And so those investors, Arch Ventures, Venture Partners being one and Human Capital Ventures being another, tremendous supporters of our mission. Big picture thinkers, long term thinkers. And so I think those have really been the key to how we built the financing for this business. And so what we’re looking for as we go forward, you know, folks who.Have a long term vision.
Amar Kendale
This is, this was never intended to.Be a quick flip.
Amar Kendale
We’re looking to build a durable business that makes a meaningful dent in this really big problem that we look at as a problem that frankly, it’s at the national scale. This is one that we really want to figure out how to fix because it’s going to impact ultimately, it’s going to impact all Americans. The way we look at it.
Brett
On the topic of thinking big, let’s think big. What’s the big picture vision? Maybe let’s go out 10 years. We can go out as far as you want or as short as you want. But let’s talk about the vision. So what’s the vision going to look like? What’s the impact going to look like five or ten years from now?
Amar Kendale
Yeah. I believe that Homeward has the potential to be a part of the healthcare experience for every rural American. And whether that’s us out front and. The Homeward brand being one that you.
Amar Kendale
Trust, or whether it’s us buried in the inner workings of care workflows and.Care delivery mechanics, because of the technology.
Amar Kendale
We’Re building, I think it can be coming from either angle.We’re doing both.
Amar Kendale
We’re building it all for the folks we serve today. We’re looking for the fastest ways to.Spread our impact and do that again.
Amar Kendale
In a responsible way that allows us to reach the most people. The reason I say this, Brett, is in part because I do believe that the shape of these rural problems is inherently different from the way that these problems show up in urban or suburban environments. And, you know, to collapse it’s physics. If you have people who are spread out and so there’s things that are. Intrinsic to that fact that mean the.
Amar Kendale
Solution has to be different. You know, a example I like here is, you know, the kind of experience we’re all watching with wired broadband and. The way that wired broadband made its.
Amar Kendale
Way, you know, to urban America and rapidly spread, you know, it grew slowly into suburban America. It has bypassed rural America. So we left rural America behind when it came to wired broadband. But the exciting thing is we’ve seen a leapfrog phenomenon and we’ve seen that.Smartphone adoption and specifically 5G adoption in.
Amar Kendale
Rural communities is faster than it is in urban suburban communities. And it’s because the need is so much greater. So I look at that as like a really inspirational kind of analogy for Homeward. And it’s almost because there’s nothing there. For us to disrupt.
Amar Kendale
We have an opportunity to really offer something that can be adopted by the ecosystem in a way that’s just much easier to distribute than in a crowded and congested marketplace. So that’s part of why I believe that really homework can be a part of the fabric of rural healthcare across all Americans, whether it’s Medicare, Medicaid, it doesn’t matter who pays for insurance. We really want to be there supporting rural healthcare for everybody.
Brett
Final question for you. Let’s end with some advice for the healthcare technology builders listening in. What’s your number one piece of advice for them to succeed?
Amar Kendale
So I think one is maybe the obvious one that I’ve been talking about, which is how do you get close to the workflows? And specifically, how do you get close to the patient? And that one, maybe that’s not the controversial one. I think most builders, most technologists recognize that user experience and getting close to the user is important. I think what people often neglect in healthcare is that there’s other users. You know, one of those other users is the provider. You know, another of those users is the payer. And so because we have this, you know, ecosystem wrap around the patient, you can’t afford to neglect anyone because that’s going to be your Achilles heel. So, you know, if you go and say, I’m going to focus on the patient and the provider, you leave out the payer and you may not get paid.
Amar Kendale
And if you focus on the patient and the payer and you leave out the provider, well, you may never get prescribed and you may never show up in the provided workflow. So you may never actually see the reach that you’re hoping for. So I think those are the places where those are the kinds of things that scare a lot of builders off. These other stakeholders that need to be designed for.
Amar Kendale
But I think it’s part of what makes these problems worthwhile. They’re rich, complicated problems, and by the way, once you solve them, you enjoy a lot of benefits. You have a great defensive moat, right? You know, you’ve built. Built your way into something difficult that makes it hard to unseat you. You know, the sort of Jenny’s got a great phrase, ankle biters.
Amar Kendale
You know, the folks who kind of, you know, see what you’re doing and think they might be able to copy you really fast. It doesn’t show up very often in healthcare, you know, the fast followers. And so I think that’s some of the reward is that, you know, if.
Amar Kendale
You can design for this more complex group of stakeholders. You can really build and solidify your position in the market and it’s durable.
Brett
Amazing. That’s a great place for us to end before we wrap up here. If there’s any founders that are listening in and want to follow along with your journey, where should we send them?
Amar Kendale
Homewardhealth.com is a great place to learn about what we’re building. You can find me on LinkedIn and feel free to reach out.
Brett
Amazing. Thanks so much for taking the time.
Amar Kendale
It was a pleasure. Thank you for having me.
Amar Kendale
Brett thanks for having.
Twitter
facebook
linkedin