From the Source with Stuart Blitz of Hone Health: Building a Provider Network

In this edition of From the Source, we sit down with Stuart Blitz, Co-Founder and COO of Hone Health, to discuss how he and his team approached building out their own provider network. We discuss why this approach was the right fit for Hone, as well as some important factors to consider when recruiting (and retaining) providers. Some highlights of the conversation include: How a simple Google Hangout can provide so much insight on which providers might be a good fit, why Stuart subscribes to the motto “Always be recruiting”, and how hiring great providers can be your best asset for a great patient experience. 

To hear all of Stuart’s insights, listen to the full audio file or read the transcript of our conversation below.

Transcript:

Mel Doukas: Welcome back to From The Source! This is our series highlighting builders in virtual care. Today, we have the pleasure of speaking with Stuart Blitz, who's the co-founder and Chief Operating Officer of Hone Health. For those of you who aren't familiar, Hone is a virtual clinic focused on hormonal optimization for men. Their offering includes at home blood testing, virtual consultations, and prescription treatment for low testosterone when appropriate. Hone launched in March 2020, and they're now operating in about 35 states. For today's discussion, we're going to be diving into how Hone built out their provider network and how they approach maintaining that network as they continue to grow and scale. Stuart, thanks so much for taking the time today. To kick things off, can you tell us a bit about Hone's current provider network? What types of providers are you utilizing right now? Are they working for you in a full-time or part-time capacity?

Stuart Blitz: Sure. Thanks for having me, Mel. Yeah, so I guess I'll talk a little bit about our provider network. When we started, we had to make the decision, do we build our own provider network? Do we use companies like Wheel or SteadyMD? We came to the conclusion that it was really critical for us to build our own network because we're going after a specialty condition. And so, we really needed to find physicians that had a deep understanding of that [condition and] a deep understanding of our patient population. And so, we decided that, look, it's going to be more work, but actually, ultimately, more valuable and provide better care for our patients. And so, we went out and found physicians that just really understand low testosterone. They understand men's health. 

It's interesting because it cuts across all different specialties. When people think about low testosterone, a lot of times people say, "That's a urologist or an endocrinologist." And we definitely have some of those specialties, but we find-  it's really interesting, in talking to physicians- we find physicians cutting across primary care, emergency medicine, all sorts of different specialties. Because, at the end of the day, they all have their own story about why they got knowledge in this area. They’ve said, "I started seeing men with this condition. I didn't know much about it. I learned more about it. And then all of a sudden, I was the expert in my practice, so I was the person they went to" or "I actually came to this area as a patient. I'm a doctor, I'm doing this type of medicine, but noticed these symptoms and went to get treatment for myself, learned about it, and then go from there." And so at the end of the day, I think that it's interesting to see where people come to this space from, and that's what we found.

MD: Great. Given that it is a very specific specialty,  like you mentioned, it's not necessarily, "I just need to go find urologists" or "I need to find this type of doctor", how did you guys approach that initial search? Was it, you met one person then you were introduced to more doctors? Did you post job listings? Can you speak a little bit about that, [about] kicking it off?

SB: Yeah. I mean, we had to figure all that out. We said, let's just start talking to physicians and learn more about: what are they looking for, what backgrounds do they have. And so, we talked to a few, then we said, "Wait a second, we're not doing this really effectively. This is our first time doing this. What should we do better?" And so, no pun intended, we honed in on the key questions to ask. The key questions to ask, and also, you could really, I would say, very quickly understand whether somebody did have experience in this area or didn't. Because we actually found that a lot of physicians would reply to a job post and would say, "Yes, I do this." [But that was] not true. [So we asked]: "Okay. Tell me about your experience with this type of medication. How do you think about dosing it?" Those are things that, of course, our medical director and our clinical staff will dig into in more detail. But I mean, you can really know a lot very quickly about [a person’s experience by asking] , "Talk to me about dosing this medication." If you've never prescribed it or if you literally prescribed it for one person or two people, it's pretty evident.And so, I would say we figured that out pretty quickly. 

I think the other thing that we found out when we were reviewing resumes, reviewing responses, you can really quickly get a sense of who could be a good fit from just from a personality point of view, and who's basically responding to 50 telemedicine jobs and playing submit, submit, submit, submit, submit. I would say those are the people that just, candidly, are not going to be a great fit for us, because they're just looking at it to say, "I'll just do whatever. I have hours to fill and I want to just do this [telemedicine]." They're ones that might be better in asynchronous consults versus all of ours are audio-visual. And so, it just depends. 

When we first started out, to answer your other question, all of our physicians were part-time. When we first started out, we wouldn't want to spend and invest all that capital hiring a bunch of full-time positions when we just didn't have enough consults to fill those slots. Now, it's the other problem. Now, we have too many consults and need to keep growing our network. We have physicians that are across the spectrum. We have physicians that basically work full time for us or mostly full time and some that work part-time, and it goes across the range.

MD: Yeah. Just going back to what you mentioned about that second piece on the characteristics beyond their clinical qualifications and their familiarity with prescribing these medications, I think that's a huge point, especially now. When I started working several years ago at Ro, pre-pandemic, telemedicine wasn't as big. There weren't as many providers that were looking to get into telemedicine, so you didn't have this crazy influx of resumes. It was a little bit harder to find people that had some experience with telemedicine or were genuinely interested in it. And now, it's almost the opposite problem where almost every provider is like, this is a great opportunity to earn some extra money or do something that's not in-person medicine if they're feeling burnout, which is great. But from a recruiting perspective, it's really important to still have that really high standard and say, who's going to provide a great experience for my patients, given the model that we have and given the way that we're interacting? As you mentioned, obviously, the video consult piece is huge. Can you talk a little bit about how you evaluate those characteristics during your interview process?

SB: Yeah, absolutely. I think I've told you this story separately. When I first started out, we would talk to physicians, talk to them on the phone, do a call. And then, we quickly realized [that wasn’t working]. [Now]  I only ever schedule Hangout videos with physicians. I just send them an invite. And if you, as a physician, can't figure out how to join a Hangout, honestly, you're not going to work out. It's just flat out, you will not be successful for our patient population and our platform. And so, of course, people that are great, they click on, they do it, [it’s] wonderful. You have [shown] some base level of tech savviness. Others... I talked to one physician recently actually, who after about 15 minutes, he just couldn't find the link, couldn't find how to get on. I was emailing with him back and forth and I'm like, look, let's just reschedule. You just have to do it.

It's not meant to be something punitive. It's just like, if you don't know how to do that, you're not going to be successful. It is actually just really a success criteria. I think the other thing is once you are on a Hangout... I mean, it's a job interview. You can really quickly understand where somebody's coming from when you talk to them live in audio-visual consultation. If you think about it, you're talking to them like this [and] they're the one going to be talking to the patients, And so, you can really quickly understand [how that will go]. I talked to one recently who was an ER doc, and literally, she was walking around in her mask and scrubs in an ER- things are beeping, and I'm like, "Cool..."

MD: I've had a couple of those.

SB: Right? And I get it, everybody's juggling their schedule. That's okay. But at the same time, if that's the impression you're going to give me, that you're carving out a few minutes to talk to us about an opportunity in the middle of seeing patients or whatever it is, then [I’m]  not a hundred percent sure, but the odds are you're probably not going to devote the right time you need to this, and it's probably not going to work out. I can quickly know that. I think interviewing, probably now 500 physicians (I don't know what we've interviewed, something like that) you learn that pretty quickly. And so, I think those are things that you learn really fast from having an audio-visual conversation with the physician.

MD: Yeah. I think it's definitely something you learn from experience. I've had many of those walk and talk interviews as well, or the ones where 10 minutes in, they're trying to figure out how to turn on their video still or turn on the audio.

SB: And it's like, I understand technical things happen...

MD: It's probably not a good fit. They might be the best doctor in the world in an in-person setting, but it's a different kind of skill set.

SB: I would say the other thing that I strongly focus on is just, why? Why are you looking to do this? Because you have this pretty wide range of answers. Some people are just like, "I've got extra time and I want to do something." And that something could be anything, to be honest with you. You have some physicians that say, "I'm transitioning out of my bricks-and-mortar practice, and I'm transitioning into a more hybrid, work from home-type role." Okay, that makes sense. Some of them are setting up their own practices, and they're just like, "Look, it's going to take me three years to really grow my practice. I don't know how I'm going to do it, so I've got time now." That's wonderful. Some people are like, "Look, in my day to day job, I'm treating X type of patients, but I have a passion for hormones or low testosterone. This gives me that."

The reasons are pretty varied, but are pretty consistent, I'd say, across all physicians. There's a handful of them that are pretty, I would say, pretty common. And for me, that's the biggest thing. Because at the end of the day, I feel like you just need to understand why, and that will tell you more about whether they'll likely be successful or not and whether you want them to see your patients or not.

MD: Exactly. I think that's even more important when you're just starting out and you're getting those first few providers. You really want someone that understands the vision that they're building, understands the mission why you're trying to create this new type of offering or this new way to deliver a certain type of treatment to patients, because they're going to be your best advocates. Not only [are] they the face of your company, they're the people that are interacting with these patients in real time. They're also going to tell you about what's working, what's not working, and how you might be able to improve things; areas that you might be able to go into, what they're hearing from patients. They're your best source of feedback that's on your side other than the patients themselves. It's so key to nail those first few provider hires.

SB: Absolutely. That, and I'll add to that too... They have to want to do it and be flexible  with you. They have to know going into it, they're going to be dealing with technology that's not polished yet. They have to know that we're going to deal with processes and things they're going to help mold as an early stage company, and they're going to help with that. I remember one physician was really confused and concerned there wasn't a dedicated admin that she would have to help her with technology. And I'm like, I understand where you're coming from, that would be wonderful, but that's just not the setup here. And so, [it’s] just not going to be a good fit. Most of our physicians are amazing. They're just self-sufficient. They just know [how to say], "I couldn't do it like this, so I did it like this. I'll let your team know how I did it." Wonderful. They're really just self-sufficient, that’s probably the best word I can use. And we love working with those physicians.

MD: Yeah. I think people that are okay working in an ambiguous environment.  A lot of people coming from clinical medicine- and I have a background myself as a nurse, so I understand this transition really well- a lot of people come from very controlled environments and very clear processes and procedures and they're used to operating in a very A, B, C, D, E way.

And [so] it's important from a hiring perspective to be really clear upfront that this is probably going to be different than what you're used to in an academic clinical setting. We don't have everything figured out. We have an initial plan. We plan to iterate on that and continue to improve, but it's not like you're going to come in day one and everything's going to be perfect and ideal and set up for you. There's a group of people that are scared by that, and there's a group of people that are excited by that and say, "That's great. I want to dive in. I want to be part of the process. I'm excited to help this grow. I want to really get my hands dirty." Finding those people is what you really need to do, especially in the early days.

SB: Totally. I think now that we're two years in, it's interesting. We've touched on: are you good at technology or not? Can you use a Hangout? That's pretty easy to figure out. I think the other two points that I learned pretty quickly were: 

Are you a mercenary or not? You know that really fast. This is the setup: "Okay, you need to talk to me for 30 minutes about training. Do I get paid for that? Do I get paid for every [minute]I'm on the clock?" And of course, our goal... Of course, we want to make sure we're compensating physicians for their time. We value their time. But there's a definite... I'm sure you've seen this too in your past experiences- there's a difference in terms of people that are really... You can tell they're at it from a "I am just doing this to make as much money as I can in the limited two hour block that I have" or [are they] physicians that just deeply care about this patient population. And so, you really want to find the latter and not the former, and you can tell [who they are] pretty quickly. 

I think the other one, which I found is a pretty accurate indicator, is how good a communicator somebody is. It's honestly, I joke it's like raising money from VC [or] it's like dating. It's all like all of that in one. If you talk to somebody and it goes really well, then they ghost you during the onboarding process and they reappear again after a week, does it mean it will not work out? No, but the odds are just much less. Because at the end of the day, understand, maybe they got busy, but they could have said, "I'm on vacation for five days. I'll get back to you when I get back", "Hey, my job's crazy. I've got four days of 12 hour shifts", all that type of stuff. Again, does it mean it won't work out a hundred percent? Of course not. But the odds, at least I can tell you over two years, the odds of somebody seeming to be a really good fit and then they just disappear or really slow in the process (you ask them for credentialing information, they don't provide it) is just really low. It just goes down that much more.

MD: We absolutely found the same thing. What we ended up doing there was just implementing a deadline of, "Listen, once you're officially hired and your contract assigned, you have this many days to do your credentialing and your onboarding", Because we just got burned so many times [by] people... You keep emailing them every week. They're going to say, "Next week, I'm going to be available. Next week, I'm going to be available." And it takes a lot of time and resources from your team that, as a small team, I'm sure you definitely don't have, and it's better just to move on from those.

SB: Yeah. And if they keep pushing it off, I would bet you, it's just not important to them. And if it's not important to them, it's not going to be important to them soon, and you want to have people that are onboarded that are [finding it] important. Because to be honest with you, what I've also found is that it's actually worse for the company, for you as a startup, to bring on physicians that are not, I would say, committed to doing this, because then it's worse. You bring them on, you spend the time, all that time getting them trained, seeing patients. And then if they don't work out or they're going to just then only do a few hours a week or then maybe stop doing it, you've wasted all that time. And so, I would much rather, at this point, just wait and say, look, they'll come to us when they're ready, and then we'll reevaluate. Not pushing them to do it. Because if you push them, then it's just... I don't think they're that committed.

MD: Absolutely. And then the other side of it too, it's not creating a good patient experience. Because if someone is only doing one or two consults a week, they're not going to be as comfortable with, like you said, the medications that they're prescribing or maybe some of the common side effects that patients are experiencing. While it is not their full-time job, I think there should be an expectation that you're going to do this in some regular capacity, because it's important to our patients that their providers have the right experience and are not just [saying], "I happen to be free this Tuesday, so I'm going to go sign on and do some consults." You want to see that commitment from them.

SB: That's, I think, an inherent difference in live audio-visual synchronous telemedicine consults to async encounters. There is a difference there. If you have two hours free during a day where you're maybe in the hospital or in your practice, you probably- you know this better than I do-  you could probably bang out some number of asynchronous consults in that time, where you just can't do that for this type of model. And so, you have to really devote time to it and you want to do that. That's, to your point, that's critical for our patients.

MD: Yeah, absolutely. Shifting gears a little bit- Now that you guys are in more of a growth phase, you have a provider network, obviously, one of the most interesting things for me when I was operating this role was: how do you balance that recruiting with the expected growth? So, how do you approach recruiting cycles? Is it something that you're doing constantly? Is it something that you ramp up and down based on projections? How do you balance that?

SB: Yeah, that's a good question. We're in an “always be recruiting” mode, at least that's how we've been since we've started. To your point, we're always recruiting. There are definitely periods of 100X push to get people on, and you're maybe a little bit, I would say, have a little more time in [than] other time periods, but you're always recruiting because you always want to have redundancy in your network. We serve 35 states. And so, we never want to be in a position where we say we don't have a provider in a particular state. Of course, we would never want to be in that position. We always have redundancy in terms of the physicians that can cover [each state]. Each state has multiple providers.

And so, we always try to strive to make sure we're able to achieve that because we want to make sure we're running the best care for our patients. I think that we also, as we grow, we always want to find the best of the best providers to have [in our network]. And so, it's always great to add more providers on because you always can reevaluate and say, "I had this group of providers that was really, really good, but wow, the next X number that I brought on are exceptional." You're continuously improving that experience and that network. We find it just important to always be recruiting and always [be] bringing new people on.

MD: Yeah. On the flip side of that, have you ever found that you brought on too many providers and there's not enough work for people? Because I think it's important- you do have to have that balance. Sometimes you're like: now we're short. Then we hire 15 people, and now I have them emailing me saying, "Hey, I'm available. I want to see patients, but there aren't enough patients for me to see."

SB: Agreed. And so, we haven't really had that issue yet, knock on wood, but it definitely is something that we have to balance because we want to bring on a lot more great physicians, but we also want to make sure they're being able to do the time that they would expect. Because even physicians that deeply care about it, they are looking to get paid for some amount of time during their week. If that time is less than they think it is, they're not going to... Nothing's going to happen this week or next week or even in a month. But, if it persists over X number of months, then at some point, they'll try to find other work to help them fill their schedule.

MD: Yeah. It's definitely an interesting balancing act. I think another aspect of that is, as you mentioned, where are people licensed and where is your volume coming from. It's always fun to try to make sure you don't have too many of one type versus another and that everyone's getting their share of the pie.

SB:Yeah, I agree.

MD: And so, as you continue to recruit and grow, have you guys thought at all about bringing on providers outside of physicians, like mid-level providers, PAs, NPs, or even supplementary clinical staff like RNs to help you as you grow? Can you talk a little bit about that?

SB: We definitely have thought about it. It's something that's always been on our mind to say- look, let's just start out with physicians and we can always modify the network later and bring on some of those. Ours is a little bit more nuanced because one of the medications that we provide are controlled substances, so there's a little bit of nuance there in terms of making sure that we have the right providers, that they're able to actually prescribe the medication the patients need. Honestly, from a simplicity point of view, we've just focused on physicians so far, just because it's less complexity. They're physicians, they can prescribe everything. But it's definitely something we're going to think about. Because also, we're going to expand to other products and other medications and other tangential areas where those types of clinical staff might be appropriate, so it's something we're definitely considering.

MD: Yeah. Have you... Right now, do you have supplemental non-clinical staff that works with the providers and assists them in terms of scheduling and things like that?

SB: Yeah, we do. We have scheduling teams, we have teams that are helping them on any prescription issues or just operational issues. And so, we have support teams that are always standing by to help them. And obviously, we've had to grow that as the company has grown. It's something that definitely helps.

MD: Yeah. It's something that, I think, a lot of people overlook when they're building out that provider network, is what does the support look like for that provider network? When you're starting out and you're smaller and you're a new idea and you have these maybe handful of physicians that are really excited about it and eager to get in, you can get away with not having as much of that. But then, as you continue to grow, as they take on more and more patients, you really have to be conscious of: how much time are they spending on non-clinical work? And is that either hurting in terms of your ability to see more patients or contributing to burnout for them? Just because you're doing virtual care doesn't mean that you're never going to have burnout or you're not going to be frustrated with the processes. How have you guys thought about that as you've started to scale up?

SB: Yeah. I mean, we've had to look at that just like the physician network. We don't want to build too much support staff or the number of consults and the number of providers that we have, but also not enough. It's funny, I distinctly remember our first handful of consults. I don't know, for the first month maybe, I was the technical support. I would literally be out at dinner and one of our providers was seeing patients in the evening, and I would help make sure it happened. That's what we did. Obviously, that's not scalable, but that's what we did. Because you have to learn: what are the issues people have? And then you get through it. But then we've, quickly as we've grown, said, okay, look, we need somebody that's dedicated to helping with schedule, we need somebody that's dedicated to helping to make sure patients are getting into their consult so there are no issues there. Obviously, if you've booked a consult for 2:00 PM on a Wednesday and you booked it two weeks earlier, we want to make sure you have that appointment. And so, we want to make sure that... We don't want the patient to be frustrated, the physician to be frustrated. And so, we have staff that's standing by to help with them.

MD: Yeah, that's great. In addition to the hiring piece of things, another really important side of maintaining the health of your provider network is obviously retaining those providers that are really excellent and that are providing great quality care. Now that you guys have moved beyond, you probably have providers that have been with you for two years now and you're continuing to grow out your offerings as you mentioned, so how do you think about making sure those really great providers are staying with you, that they're still having a good experience with Hone?

SB: Yeah, it's a really great question. Knock on wood, we've had amazing retention. To your point about two years, our first physician that joined us to start seeing patients was basically two years ago, and he's still seeing a ton of patients. It's funny, he in particular... I was with him recently. It was great to finally meet him after two years. He said this is the one of the best jobs he's ever had because he loves treating this patient population so much and it's so focused on that.

I was really pleased to hear that. It was a really nice thing to hear because that's the experience that we want. To your point about how do we [retain providers], I think there's a couple things. I think having physicians that understand the vision of the company and where you're headed gives them a lot of confidence to say, "I know where the company's going. Yeah, they're not there today. They're not going to be there in three months even, or six months, but down the road, this is where they're going." I think that really motivates physicians to understand, "I can probably provide even more help down the road." I think also just listening to the physicians, understanding: how can I make this workflow better, how can I make your lives easier, what are things that we can do as a company to make sure that we're, from a technology point of view, we're supporting what you're doing and making your job easier. Them hearing that and feeling they have a voice is actually really important and it makes them feel motivated. 

I think the other thing, and this is in the news today, I think it's what's happening. I think that physicians that feel like in the medical practice I'm working for, that there's clear clinical guidelines and I have the ability to decide what's medically appropriate for my patient, [is] really important. It's something where... They're the physician. At the end of the day, what they feel is important is up to them. It's not something that should ever be dictated by anybody else. And so, I think them truly understanding that and realizing, "This is a wonderful, I would say, model, wonderful place for me to treat patients potentially in this condition" gives them a lot of confidence and motivation to say, "This is a place that I really want to stick around long term."

MD: Yeah. I think you had two really key points there. What you were just speaking to in terms of the clinical decision making and ability for providers to feel comfortable with the care that they're providing and feel good about it at the end of the day and feel like they have autonomy and independence to a point where they can make their own decisions is hugely important. A big part of that is, I'm sure, the clinical leadership on the Hone side just supporting them, providing guidelines where needed, but not interfering in people's individual decision making. And obviously, for the business as well to not be having too much oversight there.

SB: We're not physicians. And so, we want our medical director and the physicians to decide what's appropriate. That's up to them to decide independently.

MD: Yeah. And then the other piece just about general feedback too, I think that's super critical. A lot of providers who are particularly interested in virtual care and telemedicine are also very interested in technology and how technology can be used to better deliver care, make care more accessible, so they really like being involved in that aspect of it. They're also the ones using the tools every day, day in and day out, so they're going to know what are the sticking points, what are the areas that we could really potentially improve a process or provide a better patient experience. And so, I think it's really critical to get them in involved in those feedback loops. I'm a big proponent of having clinicians directly interfacing with technical and product teams. I don't know if that's something that you guys are doing at Hone at all. Have you had any of that?

SB: We do. No, we definitely do. We're rolling out... We've built our own EMR. And so, we're rolling that out and it was great. We're getting tons of feedback from physicians saying, "This is wonderful, but here's my laundry list of things." And so, we're able to take that internally [and] look at them. There's definitely a lot of commonalities to a lot of the providers saying, "I wish it could do this." Wonderful. Those will be things that are more prioritized. We definitely want their feedback. I mean, they're the ones that are doing the consults day in and day out, so they're the ones that are using it. And so, I think at the end of the day, making sure they have a voice in it is really, I think, really motivating to them because they understand, "I gave this feedback, and now all of a sudden they're turning around and changing it." And so, it becomes a much more... It feels a lot more of a personalized tool for them. I think that's really highly motivating.

MD: Yeah, absolutely. I think that's what makes people want to stick around longer term after the initial maybe excitement has worn off a little bit, the fact that they feel like they're part of the company and they're part of the process and they're not just this other group that's off treating patients in a silo.

SB: Exactly. It takes time. I mean, I personally... We've built a network now. I personally still talk to a good chunk of our providers every month. I mean, it's not necessarily formal Zoom calls like this, or else I would have no time for anything, but it's even just... I just text them and I'm like, "Hey, how's it going? Cool." "Yes, I'm doing great. Patients are great." "What about X?" "Great." I could tell them... Even if those interactions are quick over text, it's a good way to keep a pulse of the position of how they're doing.

MD:Yeah. Another thing that we did also was, as we continue to grow, the network was going to implement more large scale surveys a couple of times a year to really get super specific feedback on the product itself, on what's your interaction like with our ops teams or our customer service teams. Are there areas we can improve there? How are you feeling about the pace of the work, the number of patients that you're seeing? Are there safety concerns that you have? Things like that. I think as you continue to grow your network, it gets harder and harder to do those individual touch points or you end up doing them with the people that you're super familiar with or are the louder voices in the room that tend to reach out, so having ways to really reach the entire or network is really great and important too.

SB: I 100% agree with that. It's different. If you think about it, just like company building, when you're a startup and you have five employees, you know everything, you talk to everybody. It's great. Then you're 20 employees. You still kind of can do that. Then you become a hundred employees and it's like, not really. Then you become a thousand employees, and it's just how you have to manage that is just totally different.

MD: Yeah, absolutely. Awesome. Thank you so much for taking the time, Stuart, to chat with me. This is a great conversation, and I think hopefully a lot of little pieces of wisdom for those out there that are thinking about building their own provider network. We'd love to have you back another time.

SB: Awesome. Thanks for having me, Mel. Yeah, feel free to reach out anytime, find me. I'm pretty accessible, so happy to chat anytime.

‍