From the Source with Rachel Blank of Allara: Going from 0 to 50 Patients

In the first edition of From the Source, we hear from Rachel Blank, founder and CEO of Allara, on how they found their first patients, what they learned from their initial launch, and the importance of building strong feedback loops early on. Apart from the great insights on what makes Allara’s offering compelling for patients, there were a few key takeaways from Rachel’s approach that really stood out:

• Understanding your patient population: Although Blank’s motivation to start Allara was grounded in her own experience with Polycystic Ovarian Syndrome (PCOS), she never assumed that she would know what patients wanted. Instead, she took a very methodical approach to understanding the needs of potential patients. From putting up Craigslist ads seeking patient interviews for $25, to starting with a low-tech pilot offering, she made sure to stay close to the ground at every step (and still does). 
• Building trust: As you’ll hear from Rachel, the process of building trust with patients is ongoing. For Allara, that means designing an expert-led program backed by clinical rigor. They demonstrate that expertise through content, reaching their target audience on social media channels and developing a long-term relationship with potential patients.
• Leveraging technology as you scale: As Allara grows, Blank acknowledges that she won’t always be able to put up a Craigslist ad and conduct interviews, but she never wants to lose that understanding of their patients. She discusses the importance of utilizing technology to gather feedback from patients, not only in the forms of surveys and reviews, but also in how they interact with Allara’s product and their care team. 

To hear the inside story of Allara, listen to the full interview or read the transcript below.

Transcript:

Mel Doukas: Welcome to the inaugural edition of From The Source. This is our series focused on uncovering the how behind successful builders in the virtual care space, and today we have the pleasure of talking with Rachel Blank, the Founder and CEO of Allara. We're going to be focusing in on how Allara found and onboarded their first 50 or so patients. For some background, Allara is a specialty clinic that offers virtual care for patients with Polycystic Ovarian Syndrome, or PCOS as we'll be referring to it today. Their approach includes a multi-specialty care team of physicians, nurse practitioners, and registered dietitians. For a quick overview, patients go through an initial onboarding process and they receive a personalized care plan that focuses on their health goals. They then meet with our provider team once a quarter and have unlimited access to their dietician for day-to-day questions and concerns. Allara launched in June of 2021 and is now serving patients across 15 states.

So Rachel, thank you so much for being with us today and taking the time to chat. To start off, I'd love to hear in your own words kind of how you came up with the idea for Allara and what made you focus in on PCOS specifically?

Rachel Blank: Yeah, well, thank you for having me. It's really great to chat with you, and appreciate the very wonderful introduction. So in a lot of ways, Allara came out of my own personal health journey. I was diagnosed with PCOS about 10 years ago, and really felt like I was kind of bouncing from doctor to doctor trying to get consistent care and support, and never really felt like I got all of the care that I needed, and especially wasn't getting all that care in one place.

The more that I started to do my own research trying to figure out what was going on with my body, the more I realized that there were millions of other women like me struggling with the same issues. I mean, it got to the point where I was sitting in Reddit forums trying to figure out how to hack my own medical care, and realized that that was just absolutely ridiculous, that in 2020, which was when I started working on this, that women were literally turning to Reddit as their source of medical care if they had chronic conditions.

This is even crazier when we consider that PCOS is actually the most common reproductive condition in the world. It affects anywhere between one in five and one in ten women, we don't even know the exact number. But it just seemed absolutely unacceptable to me that millions of women struggling with such a common condition couldn't find better medical care.

If we think about why that is, in a lot of ways it's really because our traditional healthcare system isn't set up to treat chronic conditions, and especially not chronic conditions in the women's health space. So if you think about women's health almost as a spectrum with primary care GYN on one end, specialty fertility clinics and REIs (or reproductive endocrinologists) on the other end, none of those providers are really capable of managing chronic conditions on an ongoing basis, right?

OB/GYNs are seeing you about once a year, they're doing primary care needs, REIs are doing things like IVF, egg freezing, but there's no such thing in traditional healthcare as a collaborative care team that helps you treat a multifactorial chronic condition. That's really the problem that we're solving at Allara, is we're building a specialty care layer in women's health.

Imagine a layer that sits in between the OB/GYN and the REI. So something where a woman can go if she needs care that goes beyond that annual GYN visit, but doesn't quite need the IVF egg freezing yet, or even just wants somebody to help manage her for that process.

So, that's really how we think about ourselves is building out a specialty care layer into women's health. We're starting specifically with PCOS, because it is the most common condition. However, our vision really is to be able to treat all women with all chronic conditions. So not just PCOS, but endometriosis, uterine fibroids, thyroid disease; really being that home base for women with chronic care needs.

MD: That's awesome. I love that you guys are using virtual care to, as you said, fill a gap that doesn't exist, versus kind of just making care more convenient, which is what a lot of virtual care providers I think are focusing on. Which is not a bad thing to do, but it's really great that you're going after this kind of unmet need that people have.

So yeah, when you think about that kind of chronic condition management that doesn't really exist in traditional in-person care [and] when you were thinking about what services you would need in the beginning, how did you kind of decide what to go after for the initial launch? Because I'm sure you have plans to expand in the future and there was a lot to tackle.

RB: Yeah, so it's interesting, to your point, I think we're a little bit different in digital health, in that we're not bringing something existing online, we truly are creating something from scratch. So we really are starting from kind of this blank space, not only for ourselves and our care model, but also from a patient perspective. It's not like I can easily say here's what we're offering and they understand intuitively, it's something truly that is brand new for them and that they've been desperately searching for for a long time, but that to date hasn't existed.

So for us, actually before we even started seeing patients, we spent many, many months just researching and understanding what we wanted to build and what made the most sense for our patients. I think that's especially important in healthcare. You don't want to get to a point where you're kind of experimenting with people's health. You really want to be really thoughtful about [it, so] when you're at the point when you're live with patients, that you have something that's vetted, both by the medical community and by the patient community, something that they need.

So even though I have PCOS, even though I had my own personal experience with it, I didn't want to be solely reliant on that, because for so many women, actually it can present very differently, and it's really important that you have personalized care. So, I spent months just interviewing women with PCOS.

I would put up ads on Craigslist offering people $25 to talk to me and did hundreds of hours of interviews with women with PCOS asking them: What did their care journey look like today? What did they feel like was missing? What were their biggest pain points? Where were they the most frustrated? It really helped me develop a much stronger understanding of what people really wanted versus what I assumed that people wanted.

The other thing I did was really to build out an expert medical advisory board. So we, over time, want to become the center of excellence for women's specialty care, and to do that you need to make sure that your care is expert-led and expert designed. So, we built out a medical advisory board of some of the leading providers in the PCOS space. For example, Dr. Heather Huddleston, who is the director of the PCOS clinic [at UCSF] is considered one of the leading experts on PCOS in the country, is on our medical advisory board. Dr. Beth Rackow who is an REI at Columbia is on our medical advisory board.

So while I was also researching with patients, I was working with this medical advisory board to really make sure that we were delivering something that was at the cutting edge of science and was going to really deliver better care outcomes. So I'd say to any digital health founder, these are two things that I could not recommend more: doing the research, both with patients, but also doing the research on the medical side and making sure that you're offering what patients want and what they need.

So that was how I decided we were going to launch with, and it became very clear that one of the biggest pain points was around metabolic disease. So many of the women we were talking to wanted support, not only for PCOS and from that medical perspective of working with a GYN, but they really wanted to work with a nutritionist as well and have a collaborative environment. So that's how we ended up launching with our initial program that paired patients with a doctor, as well as a nutritionist.

MD: That's awesome. I love how you mentioned that even though you had this personal experience with PCOS, you went and did the research and took the effort and time to talk to other people too. I think a lot of founder stories come from personal experience, which is great. There's something that kind of catalyzes the idea or the need for whatever you're building, but it's really important to understand that everyone's experience is going to be unique, and [think about] who are you really building for and who is your kind of initial patient population.

RB: Yeah, exactly.

MD: So on that note, did you kind of know after talking to all these women what your initial patient population would look like and did that inform how you went and found those patients?

RB: So, it's interesting. Our patient population, it looks similar to what I thought, but a little different, and so I had a multi-step process of research before we launched. So, [the] first step was these very deep dive customer interviews. The second step was actually, I wanted to understand at a more scalable large level what our patient population might look like and what they would need.

So again, before we launched any care models, before our PC was even really done, we launched a waiting list. So I put up an LP, our landing page, that explained what we offer, what our care program was, basically this vision I had of what it would be. Then I started running Facebook ads to it and let women sign up for a wait list based off this landing page. So the idea was that not only would I have a captive audience ready to go when I launched my product, but I could also use that to get much better data at a bigger scale than I could with these one-on-one interviews. Through that, I was able to understand things like: what states do all of these patients live in? What are the most popular states? That drove my strategy around state expansion. I used that wait list to rank the different states I was going to launch in. I also saw how old people were, what age level were we serving? It turns out that our sweet spot was women in their mid-20s to mid to late 30s.

I also was able to ask women, when they signed up for the wait list, I would ask what's your number one goal that you want to help with? Again, that really helped me at a bigger number scale understand: what did I want to launch with. And frankly, it also helped me test demand and really validate, okay, I've come up with this idea, let me make sure that people actually want it. So we ended up building, before we even launched, a wait list of almost 5,000 people, which to me really validated that we were building something that people truly wanted.

MD:That's awesome. I think that's so smart to think about it in terms of patient goals as well. That's what not a lot of people get in traditional healthcare is [providers asking], what do you want? What are you trying to achieve? Not: here, let me tell you what healthy is and how to get there. So, I love that approach. So, when you were kind of ready to move from that wait list to, okay, now we actually want to bring people on board. You mentioned earlier that this was a new care model and not just a new way to get care for people, so how did you kind of approach building trust with these initial patients to say: we're legitimate, we can actually help you in different ways and trust us with this really important piece of your healthcare?

RB: Yeah, I mean, that is really tough and that's something that we think about every single day is how do we build trust with patients, how do we become this trusted brand authority, frankly not only with patients, but with providers as well? My worst case scenario is a patient goes to their doctor and tells them about us, and they say, "What are you talking about? That's a ridiculous way to treat what you're doing, that doesn't work." I think that is something I have heard about other startups in digital health is that they don't necessarily have buy-in from the medical community. So again, as I think about building a trusted brand in a space, it's with every stakeholder, it's with patients as much as it is with providers.

So again, I think, one, that was really basing everything we did in science. So we leaned on our medical advisory board, we also from the very beginning brought on a full-time dietician to lead our nutrition programming, and she is literally a walking encyclopedia of nutrition knowledge. Every single thing we did, not only from the medical side, but from the nutrition programming side as well, there is a scientific study that goes behind every single recommendation that we have.

Then we just started to voice that to patients and potential patients. We started investing in content very early, and in the content highlighted how scientifically based all of our resources are. We also led from personal stories. So, I have popped up on a TikTok once or twice. I have an awesome social media manager who also has PCOS who is often on our social accounts, but we really leaned into our personal story as well just to show this is coming from a place of people who get it. I think that was able to really lend us a lot of authenticity that built trust in the beginning.

MD:Yeah, that makes a lot of sense. Obviously knowing your patient population was kind of in that age bracket and thinking about how to reach them, the whole social media content approach makes a lot of sense too. Myself being in that bracket, I rarely look at something once and then decide to go through with it or make a purchase. This is obviously a much bigger decision than a purchase, so having that kind of backup makes a lot of sense.

RB: Yeah, and that is something that we have realized is that this is not like buying a sweatshirt where you see that and then you buy it. A lot of times patients will learn about us, and then it takes a month, two months, three months for us to build the trust, build up that credibility and then to become a patient. So just by understanding that, we're able to craft our brand and craft our storytelling in a way that actually builds that trust, as opposed to just trying to push them to buy something right away.

MD: Absolutely. So when you guys had this kind of initial cohort that you brought in and were serving them, can you talk a little bit about the learnings that you got from those first few patients and how you maybe adapted your strategy or your offering at all based on feedback, what was going well, what wasn't?

RB: Yeah. So again, you'll see I really staged out our launch. Even before we launched our full program, we had a private MVP going. So what we did with that is we didn't use the doctors, because we have always made sure that we are very much by the book from a regulatory perspective, but we just offered to potential patients to do a pilot program with their dietician. So we had about 20 patients come through and work with our dietician for two months, and we really wanted to understand: How do they like to engage with their providers? What were they getting out of it? Making as many tweaks as we could before we actually launched the full program. So, an interesting thing that we found was that people really wanted ways to engage in between visits. So in addition to having the video visits with the providers, patients are actually able to text with their dietician every day. That was something that came of that kind of pilot MVP launch that we did. Then when we first launched to market, we launched with our collaborative care model with the doctor and the dietician, and we just stayed really excited.

I mean, I personally to this day call patients all the time to ask them how it's going. A lot of times I'll do consultations before people sign up for the program. For me, it was just really important that we were constantly staying really tight to the patient and what they needed.

Another great example of something we learned was that a lot of people weren't sure if they needed the program, they weren't sure if they had PCOS, and so after we launched our collaborative care model, we launched a one-time diagnostic offering at the end of November. That allowed patients to do at-home blood work, get all of their hormones tested, get a lot of other biomarkers tested and then meet with a doctor for 30 minutes to see what is going on in their bodies. So, that was actually a really appealing option to people to have this one-time diagnostic, as opposed to just the subscription model that we launched with.

MD: Yeah, I think that's a great offering. It allows people, to your point, [to try out] A, if they don't know if they're a good candidate, and B, just to learn more about you. Not commit to the full program, but learn to trust your providers and that you are actually following through on what you're promising on your website and everything. So, that makes a ton of sense.

You mentioned you're still really close to the patient experience now, I'm sure everyone is. When you think about as you continue to scale, obviously that will be harder and harder to remain super close to your patients. How do you think about maintaining those feedback loops and making sure you're close to the experience as you guys continue to grow?

RB: I think this is where building in digital health and using technology is a massive asset, right? If we weren't also leveraging tech platforms and smart tech and I was just personally calling every single patient to get feedback, I think it would be impossible. But as we think about building our practice and building our clinical protocols, we also think about how do we build on technology that allows us to, A, make sure that we are delivering the highest quality care, B, enable all of our providers to operate at the top of their license and really focus on the medical care, the nutrition care and not the administrative work. [And C] really track patient outcomes, patient satisfaction, and intervene as we need to.

So, that's where we are really excited about technology platforms like Source [and] about the proprietary tech that we're building. A lot of where we're making investments in our tech is around, number one, tracking patient outcomes, making sure that if we tell you that you're coming to us, you're pre-diabetic and we're going to help you, that we actually are tracking that over time and we're proving that we've helped you move out of the pre-diabetic range into the normal range. Or if we're telling you that we're going to help with fertility, we're helping you track your ovulation, we're helping you track outcomes there. Then also really staying close to the patient in terms of feedback [and] engagement. So even if they're not giving us feedback, have they stopped responding to their dietitian for the last two weeks? Well, then we should probably send in a message. That's where we really get excited about the opportunity of tech to really help us, not only stay close to the patient, but use that information to drive even better patient outcomes.

MD: Yeah, and a lot of times you can learn so much just from, to your point, what people are doing or not doing and how they're engaging with you. Not even like, "Oh, I left this review and I enjoyed my visit or I like these services," but how often are people actually utilizing them and what's their behavior over time.

Well, you've given such great tidbits and tips for people I think in the same position. Is there anything that we haven't covered in terms of that initial zero to one or 50 patients that you want to go over?

RB: Yeah, I think one thing that was really important to me as we were building out was not only thinking about the patients, but also thinking about the providers on our platform. I think as we think about the people that we're serving, it's really important that we serve our patients incredibly well, but it's also really important that we serve our providers incredibly well, because at the end of the day, our patients are building long-term relationships with their providers. They're coming to us, because they're seeking a level of care that they can't otherwise get.

So it's really important that we not only are able to recruit the best possible providers for our patients, but also retain them. So, that is something that we have been very thoughtful of is not just creating a great experience for patients, but creating a great experience for providers so that we can attract and retain the best possible providers.

MD: Absolutely. That is music to my ears obviously as a former nurse. I'm a huge believer in the fact that you can't have a good patient experience without a good provider experience, because if you're not giving your providers the tools and the knowledge to deliver high-quality care,  you're not going to get it for your patients. So it's absolutely a two-sided approach and I love that you guys are thinking about that. It will certainly serve you well in the future.

RB: Yes, and I always say PCOS patients and patients with chronic care needs tend to get really frustrated, but I always like to say the issue often isn't the doctor, the issue is the setting in which they're practicing. So by giving them a better setting to practice in for these patients and it aligns better with their patient care needs, it actually solves a ton of the issues and turns out the issues weren't the provider after all.

MD: Exactly. So smart. Well, thanks so much again for taking the time. Really enjoy chatting with you about Allara and I'm sure everyone will find all of your insights super helpful. Loved having you [on], and I'm sure we'll be talking again soon.

RB: Yes, thanks so much for having me.