Rob MacNaughton Transcript
Clint Betts
Rob, thank you so much for coming on the show. You are the CEO of Calibrate, which is a fascinating company with the rise of Wegovy, all of those types of drugs. I can't believe I'm missing some, Ozempic…
Rob MacNaughton
Ozempic, Mounjaro, Zepbound. There's a bunch of them now.
Clint Betts
And this whole idea of how do you lose weight using that type of medication, but also changing your own lifestyle and things of that nature. I've not used these things. Obviously, I've thought about it, but I haven't used it. So tell us the advantages, disadvantages, and what Calibrate does in the mix of all of this.
Rob MacNaughton
Well, certainly. First of all, it's great to chat with you, so it's a pleasure to be on the podcast. We do at Calibrate, and we were a pioneer in this space five years ago, was essentially dovetailing very powerful anti-obesity medications like the ones you just chatted about there, and to essentially physician and clinician-led lifestyle intervention and coaching platforms. So, there are a number of different anti-obesity medications. The ones that are getting much of the mainstream press attention lately are these GLP-1s. And so those are Zepbound as well as Wegovy and Ozempic. And these are very, very powerful drug therapies. At Calibrate, we have been utilizing these drugs in combination with lifestyle change and intervention platforms for about five years now.
Our viewpoint in this space is that these medications are figuratively and literally not the magic pill. They're very powerful, and they help people lose weight. However, if people are just on the drugs alone and then they come off the drugs, all the research shows that they'll gain the weight back and sometimes more. For us, the real impact of our physician-clinician lifestyle intervention and coaching platforms is that it allows people to lose weight, actually more weight than if they were just on the drug alone, but more importantly, keep the weight off. And we have best-of-breed results on this.
To my knowledge, we're the only company that actually publishes our results. And just to give you an idea of the impact, every year, we publish our results, and for our most recent year, we published the results that we published this January. This was a big sample, and it's like 16,000 people. Over the course of the first year, our members lost, on average, 16% of their body weight, which is much larger than just on the drugs alone. And then, at the end of year two, they lost 18% of their body weight. And so what really should stand out there is that not only did they keep losing weight, but they kept the weight off.
And that's really frankly a testament to the gravitas and power of our clinician-led lifestyle intervention coaching platform. People can make changes in their daily habits. And our curriculum focuses on what would be, I guess, traditional pillars of cardiometabolic health. So there's diet and nutrition, sleep, exercise, and behavioral health, but it's really the combination of the most appropriate medication for an individual at their stage of the journey in conjunction with the lifestyle intervention and coaching platform.
Clint Betts
Yeah. What do you think? There are, obviously, a lot of studies. A lot of people are using these drugs. There are a lot of people who are saying, "Hey, they might not be great." There are a lot of people saying, "They're great." What do you think? Are they safe? Do you feel good about them?
Rob MacNaughton
I do. And I think the research at large is pretty supportive of that fact. These GLP-I drugs, although they've been utilized for weight and obesity management for the last four or five years and really coming into the cultural mainstream of the last, let's say, 24 months or so, these drugs have been used for diabetes in the early 2010, 12 timeframe. So, these medications have been around for a while, used and studied for well over a decade. And although a subset of the population may have side effects, for the most part, they're relatively minor. And particularly if you are being managed with a... If your prescription is being managed by a physician, they can work with you to mollify the impacts of the side effects as well. But for the most part, these drugs are incredibly safe, particularly under the guidance and use of a physician.
Clint Betts
With your physicians and coaches on the platform, what would a typical week or month look like for somebody who joined Calibrate?
Rob MacNaughton
As they first come on board, we'll do a clinical health intake assessment and learn about their medical history. Because for some people, GLP-I drugs may not be the appropriate path given their medical history. For others, GLP-I drugs may be essentially utilized for much longer than just what their weight loss journey is as well. So they work with the physician to just get a better understanding of their cardiometabolic and, frankly, medical history in general. We typically also then work with the member's insurer to see if this would indeed be covered by their insurance. Once we go through that process, we will then prescribe the most appropriate medication for the member. And at that point in time, they're meeting with our coaching team. So, we have coaches who will work with them through the curriculum of our clinically-led lifestyle intervention coach platform.
They meet with the coaches. Speak with us virtually every two weeks. That's typically the rhythm they connect with the coaches every two weeks. A member is also sent a wireless-enabled scale. So when they get on the scale, we're automatically tracking, and we're able to monitor their journey. The coaches are there to help them walk through the curriculum if they have any questions. If they're either plateauing or having some aspects in their weight loss journey, we find that our coaching cadence and frequency really do drive accountability and results as well. And then they'll typically meet with doctors when they're at different stages of titration, either moving up in dosage or moving down in dosage after some weight loss gains have been made as well.
Clint Betts
And so how did you figure all this out? What's your background? How did you come to do this?
Rob MacNaughton
So, I joined Calibrate as CEO this January. My background up until this point in time seemed very relevant, and I'm excited and honored to be part of the team here at Calibrate. My background started out in management consulting decades ago, and I'd spent most of my time in software and technology. Then, I moved into the video game space, where I was the GM and the president of a video game company. But my career took a pivot towards healthcare, and I think, like many people's, it's usually due to personal reasons. My story was about a family member who was battling the latter stages of cancer. As a family, we were looking for home healthcare options and, frankly, were pretty disillusioned and distempered with the choices available to us at that time.
And so, in retrospect, rather hubristically, I thought, you know what? I can do better. I had started my own companies before, again in the software space and the internet space, nothing to do with healthcare, but I just saw so much opportunity and need for better home healthcare solutions for families. So, I stepped away from being GM and president of a video game company to start my own home healthcare and hospice-supportive company here in Portland, Oregon, where I live. So, I hired a team of clinicians, MDs, NPs, and docs to help me get licensed and credentialed to practice home healthcare and hospice supportive care here in the Pacific Northwest and hung up my shingle trying to cater to families and referral sources looking for a... Hired to be professional and responsive from their home healthcare partners.
And fortunately, that positioning resonated. Within a few months, I had a few hundred employees, the vast majority of which are part-time and hourly certified nursing assistants and personal caregivers. However, the care model we had really resonated well and grew to a few offices, and ultimately, we ended up selling the business. However, we still stayed really involved in long-term and post-acute care. But at that time, I shifted more to the investor side, investing in assisted living and skilled nursing communities. From a career standpoint, I actually spent the next several years of my career in veterinary medicine, so I still very much healthcare, but on the companion pet side of things and led hospital operations for the world's largest veterinary practice. And by the time I left, we had 5,000 veterinary clinics and 80,000 employees. We would see tens of billions of pets in a year.
And for me, I love the pace and innovation in that space. Veterinary medicine, although healthcare doesn't have some of the innovation headwinds that you might face in human healthcare, got lured back into human healthcare, this time on the payor side of things. So, I really got a deep look into, I'll say, the economic engine of U.S. healthcare, as well as access. Payors are certainly the way that many people have access to healthcare. While there, I worked for one of the multistate Blues. I really learned how to roll out, I'll say, innovative new models in technology and solutions ultimately aimed at increasing access to care, reducing the total cost of care, and, more importantly, improving patient and healthcare outcomes. I learned a lot about rolling out those solutions at scale.
From there, my arc was as a health tech CEO. So I led a company that was in the clinician staff and the scheduling space and then moved into a telemedicine virtual care platform, again, focused more on the post-acute side of things. As my career continued to progress, I started doing more and more board, executive board, and director work and advising. Prior to joining Calibrate, I was in the venture capital space with a fund called Redesign Health, which specifically focuses on early-stage healthcare innovation. I was enjoying that immensely. Then, the Calibrate opportunity came up, and I became familiar with weight-obesity management solutions. And from my vantage, Clint, I think this is one of the few points of light in our healthcare sector that has the true promise of reducing the total cost of care.
More importantly, at the individual level, these results are truly astounding. It is life-changing results at the individual level. And then, to think at scale, this could have the impact of reducing the total cost of care. I was enamored with that. It seemed like a capstone to a lot of the work I had done on my career journey to that point. I have a background in software and a background in multi-unit healthcare ops. I had an understanding of the payor space, and this just felt like it was a great meld and intersection of all those things. And yeah, I was really excited to have the opportunity here at Calibrate.
Clint Betts
Yeah. What I like about what you're doing is you're going after the cause, not the symptom, right? And so, why are we as unhealthy in the United States? Because the cost comes when you have to go see the doctor. That's where the costs start racking up. But if you can do preventative type things, which is what you're advocating for here and which is what Calibrate does in conjunction with these pills, it seems like that's the right way to go.
Rob MacNaughton
Absolutely. Obesity, particularly in the U.S., is an epidemic. It's the most daunting chronic condition that we face. Over 42% of U.S. adults are clinically obese. Close to 75% are clinically overweight. Obesity is just a driver or is affiliated with many of the other most prevalent chronic conditions, whether it's hypertension, cardiac-related chronic conditions, diabetes, and, of course, sleep apnea. My analogy is that obesity is like the centerpin in bowling. If you can knock it down, you can have an impact on a lot of other things that are frankly driving a lot of poor healthcare outcomes and driving a lot of costs within our healthcare sector today. And so yeah, by focusing specifically on weight and obesity management, I think we can have an over-indexed impact on the broader healthcare outcomes as well as cost implications.
Clint Betts
What does a typical day look like for you as CEO?
Rob MacNaughton
So, Calibrate is fully remote. It was a company that was essentially launched in the 2019 and 2020 timeframe. So, just prior to COVID, but certainly as a company, we started scaling in COVID, and we're largely a remote company. I live on the West Coast. Much of my team lives on the East Coast and in the Midwest as well. So my day starts early. I probably work, I'll say, central time zone hours if you will. So usually I get up and just... I typically connect with our leadership team just to make sure we've got a pulse on everything that's going on. And yeah, for me, it's leading a company in a remote environment, which is something I've had experience with in my previous roles as well.
But there's a lot of time on Zoom. I will say that. We try to connect with the executive leadership team in person at least once a quarter, if not more. And that's important, especially as we continue to build and scale here at Calibrate. My days are spent on... I'm really trying to focus on what we call our strategic imperatives. There are things that we're trying to focus on, and I have a phenomenal team. For us at Calibrate, we see ourselves as a clinical care company. We're a clinical company. Yes, we utilize technology, but at the end of the day, the core aspect of Calibrate is that we're treating members in their weight and obesity management journeys.
Clint Betts
What have you learned about leadership doing a fully remote company? How can someone be a great leader in an entirely remote company? I'm sure so many leaders are wondering how that works.
Rob MacNaughton
No. It's a great question that I feel I'm still always adding to that arsenal as well. I will tell you as I reflect on it that some of my observations are, I think, actually leading innovation in a remote environment, which is more challenging, full stock. What I really did like when everyone was in an office is that if there was an idea or a problem came up, you would just have to walk down the hall and chat with someone who would be involved in the solution or the diagnosis of the issue. And there was a bit of spontaneity, and things would just happen. I find spontaneity in a remote world more difficult. You have to schedule time to connect with people, and it can be challenging. Even at Calibrate, we're not a huge company. We're a couple of 100 employees, but even getting time on the calendar can be a challenge. So, just the pace of innovation, I think, can be challenged unless you are really thoughtful and intentional on that as well.
And so that's why at Calibrate, the executive leadership team, we have standing meetings in such a way that we try to create a forum for spontaneity if you will. It almost sounds ironic to plan for spontaneity. But that's what we're trying to do, which is essentially have the forum for this stuff to come up. Because healthcare innovation is hard, it's a team sport, and it's quite iterative as well. And so you need to have that, I'll say, baked into the processes. I think what is also challenging in a remote environment is just the alignment across the board from the CEO to the folks who are working with our members day in and day out. And that takes, I'll say, relentless prioritization and communication. And I'll say, repetitive communication. When you think you've done it enough, you're probably halfway there in terms of cascading messages down to the team.
And so for us at Calibrate, we're doubling down on that actually right now. Well, in terms of ensuring the team is focused on our key priorities and initiatives, it's been a thoughtful and intentional process now as we're rolling that communication out and trying to define people's roles, responsibilities, and accountabilities as well. But that's for me; the challenge is the alignment side of things and just to make sure that people understand how things fit and how decisions should be made. Because our goal is to empower folks closest to our members who are to make those decisions. And that can be very, very, very challenging.
Clint Betts
Oh, yeah. Well, it must be useful from a talent perspective. You can now hire from anywhere. That seems like an enormous advantage.
Rob MacNaughton
Absolutely. I think from a talent pool standpoint, removing any geographic restrictions is certainly powerful. So, we are also very fortunate at Calibrate that every member of the team is fully supportive and driven by the mission. That's a benefit that I think being in healthcare, in general, is that there are people who are on this journey with you on the team that is there because they're in it for the mission and the cause. And that is, I think, a powerful enabler for us. Then it becomes our job as leaders to ensure that we're harnessing that advantage, but it's telling you how the mission and cause are linked to everything. So, we have our mission. We have the strategic imperatives. So those are the strategic focus areas that we're working on that we believe will essentially augment our ability to carry out our mission, and then from those strategic initiatives come work streams that fall out, whether it's product roadmap, process improvements, team, or human capital planning.
But everything needs to be tied into the mission, and it becomes really a focus on how you communicate that to the team so they understand and they're aligned and just the part where they feel they have input in it as well. What are the... I think the challenges in a remote environment are on the innovation side of things. And in terms of, I'll say a leadership paradigm, I would love it if everyone on the team agreed on a certain path, and that's what we'd have to do. I have found that over my career, it can be a challenging thing to get that consensus. And you can do it, but I think it usually comes at the expense of time. When you're in the early stage of healthcare innovation, time is not necessarily one of the inputs that you have a lot of. And for us, I think at Calibrate, the focus is really on alignment versus agreement.
We want everyone to align on the path, and align doesn't necessarily mean agree. Align means that we as a team have decided to go this route, and the focus is then execution on that. And for me, I think one of the key aspects to ensure that the alignment model works and is successful is that folks on the team feel that they have a voice. So, if they have an opinion, it is heard. You create the forum. You treat the vet. You create the venue for people to voice their thoughts and their input. Once a decision is made, even though it may be different from their perspective, we can all commit and align to go forward. So, giving people the opportunity to voice their input in the venue is huge. But the agreement is a tough hurdle to get. Alignment is what we're focused on and doing. So I think allows us to keep that pace up.
Clint Betts
How are you thinking about artificial intelligence? How are you implementing it?
Rob MacNaughton
So, for us, it's a journey. Right now, we see and utilize AI as a tool to make our teams more efficient and effective. So whether that be in aspects of chatbots or decision call escalation and call routing, how it's really being utilized today for us is more on, I'll say, the member experience side as opposed to the clinical experience side. I try to keep up with AI and the advancements in AI as much as possible. I've been involved in, I'll say, the implementation of AI for almost a decade now. And it's been interesting to be part of that journey, especially over the last 12 to 18 months, just how fast it has grown. There was a definitive hockey stick there around the chat, GPT-3, that I launched. But for us, it's really seen as making the lives of our coaches and our clinicians. At no point in time or have we provocated using AI on the clinical side, if you will, and as I continue to read, the advancements that have been made are pretty impressive. AI can now pass MCATs and diagnose certain elements better than human doctors, apparently, but that's a different world. So right now, I would say we have a pretty strong delineated wall or barrier between the use of AI on the member side, on the member experience side, and on the critical experience side. However, in terms of areas where I think it could be helpful on the clinical side, it is when it comes to prescriptions and medications. That can be a blind side in people's healthcare teams.
You'll have multiple different providers prescribing medications, and in many cases, there's not one nexus or point of contact on the care team that has a full, robust point of view. And as I think about it, there may be ways in which AI can help with that, at least the tracking of that to ensure we have a full and holistic view of folks' medications. Because it can lead to some pretty significant downside issues with contra [inaudible 00:25:44] and just lots of medications that have been prescribed when there's not necessarily one person playing point on it all. And perhaps that's an opportunity in the use case if there's one we have not gotten into. But I think that is an opportunity for AI that could be helpful.
Clint Betts
Yeah. Yeah. It does seem like AI is rapidly growing to a point where, who knows what it's capable of in five or 10 years, right? But you've got to think about what it is capable of in five, ten years, and what it is capable of in the next six months. It's an interesting challenge as a leader.
Rob MacNaughton
Yeah. And it makes long-range planning with AI challenging, just given the rate of acceleration within it. So I think of us when I look at our product roadmaps; it's typically six to 12 months. Anything within six months is a little bit more concrete stuff. Six to 12 months is a little bit more malleable. The focus right now on AI for us is really seen as efficiency-defective tools on the member experience side. And just I think it can help with some asynchronous communications and really dealing with some member issues that may not be clinical, but helping address and ideally we solve them more quickly.
Clint Betts
Finally, we end every interview the same way with the same question. And that is, at CEO.com, we believe that chances one gives is just as important as the chances one takes. When you hear that, who gave you a chance to get you to where you are today?
Rob MacNaughton
That's a fantastic question. I was fortunate enough to have an opportunity to start and found a company coming out of business school in my mid to late 20s. And that opportunity, starting my own company and becoming an entrepreneur, was a huge, huge inflection point in my career. At that point in time, I was then able to have the confidence in myself to build things myself, hire teams, and try to have an impact on things that mattered most to me. And I don't think I would've had the career I've had today without that first founding of a company. It was, again, a customer relationship management software that was focused on the automotive space and had nothing to do with healthcare, but it was a business school classmate and me. We founded the company, and not only was my colleague, Thomas, incredibly important in that, but as I think back, it was the gentleman who wrote the check to fund us.
His name is Jim Lavalle. He was the CEO of a very successful technology company, and he saw a glimmer of promise in Thomas and me and what we wanted to build, and he wrote a check to fund us. And I think without that catalytic event, my career would've been very, very different. And I think about Jim a lot. Today, I am a seed or an angel investor in a number of technology companies, and I wouldn't have had that opportunity without his confidence and conviction in a couple of guys in their mid to late 20s. And I think that was a big bet for him. It's not like we had pedigrees and track records back then, and yet he saw something in us, and I'll be forever grateful for that.
Clint Betts
Rob, thank you so much for joining us. It's been incredible to hear your story, incredible what you're doing with Calibrate. Best of luck with everything. We should have you on in six months to a year, and just get an update on how things are going, because the whole world's going to be different then.
Rob MacNaughton
It is a space that is characterized by a lot of fluidity and change. I would love to, Clint. It would be fun to catch up.
Clint Betts
Thanks, Rob. Really appreciate it, man.
Edited for readability.