Like many healthcare startups, Fruit Street Health has experienced many twists and turns in its evolution as a telemedicine company with multiple products. In an interview with MedCity News, CEO and co-founder Laurence Girard discussed the company’s product offerings, business model and its focus on building a community of physician investors, as opposed to seeking funding from venture capitalists, all of which are reflective of the company’s mission and journey.
After perceiving a growing need for digital health tools to manage chronic conditions, Girard founded Fruit Street Health in 2014. While serving as an ER volunteer, Girard took a course in nutrition epidemiology at the Harvard Extension School with a Harvard School of Public Health professor, which changed his initial plans of attending medical school.
“I realized that we can prevent chronic conditions like heart disease, diabetes and stroke through diet and lifestyle. I also started reading about physicians like Dr. Dean Ornish who proved you could reverse heart disease through diet and lifestyle modification. It made me think I could have a bigger social impact through a combination of technology and entrepreneurship in the field of public health.”
In its first phase of business development, Fruit Street created a telemedicine software platform that would eventually be licensed to physicians and dietitians. For the first three years the company was developing telemedicine software and striving to find product market fit. It ultimately succeeded with strategic developments and the formation of critical relationships. Fruit Street found success when it pivoted its business model from telehealth software to delivering the CDC’s Diabetes Prevention Program.
In 2017, Girard successfully registered the company for the CDC diabetes prevention program based on advice from a Fitbit executive. Fruit Street eventually got a stamp of approval from the CDC when it achieved full recognition. In order to achieve the full recognition designation from the CDC, diabetes prevention programs must achieve outcomes such as 5% average weight loss for participants that take part for at least nine months.
Fruit Street’s flagship product is delivery of the CDC’s diabetes prevention program via telehealth and live group video conferencing with registered dietitians. The program is designed to help patients with pre-diabetes lose 5% to 7% of their weight to reduce their risk for developing Type 2 diabetes. The program is based on research CMS funded that was published in the New England Journal of Medicine which proved that the diabetes prevention program helped patients with prediabetes reduce their risk for Type 2 diabetes by 58%.
It involves screening patients via a Type 2 diabetes risk assessment. If the results indicate the patient is at risk for the disease, they will be entered into a weekly telehealth program aimed at managing health and preventing the chronic condition. Members not only participate in the weekly group classes, but also share photos of their meals with dietitians providing feedback. They also use a wireless scale and Fitbit to track their physical activity.
When asked about the impact of the current public health crisis on Fruit Street’s business, Girard said Medicare’s loosening of telehealth regulations has helped attract more customers. He noted that the CDC promoted Fruit Street’s software as a solution for in-person diabetes prevention programs to switch to delivery of the program online via telemedicine during the pandemic.
“We’ve seen a big shift from these in-person diabetes prevention programs to adopting telemedicine relatively quickly,” he said.
Rachel Neifeld, a registered dietitian, is among Fruit Street’s recent hires who have helped thrust the company into pole position. She leads the digital diabetes prevention program. Previously, Rachel served as an inpatient dietitian at Montefiore Medical Center and New York Presbyterian Hospital, then as an outpatient diabetes educator at Beth Israel Mt. Sinai Endocrine Center.
In late April, Fruit Street hired Chief Technology Officer Ian McFarland, who served in a similar role at Pear Therapeutics, a digital therapeutics business. In fact, it was McFarland who persuaded Girard to expand Fruit Street’s offering to include a service aimed at preventing and treating the coronavirus.
Fruit Street Health launched CovidMD at the height of the public health crisis, during which the country’s struggle regarding the need to address public health and the need to restore the economy was at its peak. The risk assessment, triage, and telemedicine platform, built on the Salesforce Service Cloud and Zoom, tracks sources of domestic exposure and pre-existing chronic conditions as part of a proprietary risk scoring system. This system generates both an exposure risk score and a health risk score for each person. Then, users are provided with personalized information about next steps, based on their risk scores and the latest CDC guidelines. They’re also given the option to connect with a healthcare provider via live video, who will be able to take actions such as write a prescription or order an at-home test for Covid-19.
Eventually, Fruit Street plans to develop a more holistic telemedicine solution that will include behavioral health with psychiatrists and psychologists via live video, virtual primary care, and dietitian-based services which Fruit Street already delivers.
Fruit Street’s investment model is what sets the company apart from the myriad of telemedicine companies on the market. Rather than utilize venture capital firms for funds, the company focuses on physician angel investors, who also function as advisers.
“I realized that I enjoyed working with the physicians that had invested and they were the ones who were more focused on having a social impact,” says Girard. “I wanted Fruit Street to be a grassroots effort of physicians who want to have a social impact in public health through the power of telemedicine. I wanted to focus on physician investors rather than venture capitalists because physicians know more about healthcare products than a venture capital firm. What if a physician could use my product or tell me how I should design it based on their experience working with patients?”
Asif Ali was the company’s first physician-investor, a cardiologist at the University of Texas in Houston.
Physicians tend to invest between $25,000 to $50,000. Girard noted that many tap an IRA/401k to invest in the business. Recently, Fruit Street launched a crowdfunding campaign on StartEngine to offer a wider range of investment points for a wider variety of physician investors, demonstrating the company’s value for its physician community, as well as its dedication to improving Fruit Street’s program for patients and user experience for physicians.
“Physicians develop clinical protocols, but they also talk to each other. I don’t start every discussion — a physician can post an idea and other physicians can respond in real time. So it’s really kind of like a collegiate forum where we discuss everything and anything. And then we’ll have weekly updates on Zoom, where we’ll share progress made on the product and the business impact in the chat box or just share their comments on product design and clinical protocols. They might make helpful introductions to potential customers; they might recommend colleagues to invest. Some of them use our telemedicine software in their practice. Some of them are actually telemedicine providers.”
Girard has had a long journey in the telemedicine industry. He noted that his idea started on a napkin which has now grown into three telemedicine products that are having a social impact on diabetes prevention and providing medical care online.
Looking ahead, Girard envisions building a physician community of 10,000 that will serve as a hub for expert insights on product development and solidify the company’s position for future growth.
Photo Credit: Zoom Video Communications