Common Sense Medicine
Common Sense Medicine
#78 - Solving Low T in men with Hone Health
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#78 - Solving Low T in men with Hone Health

Stuart Blitz, COO of Hone Health, joins me to talk about operations in D2C tech-enabled services
Transcript

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Welcome back to Common Sense Medicine! This is the last post of the year, moving into the holidays, so wishing you happy holidays and a happy new year.

In this episode, I’m joined by Stuart Blitz, who is the Co-Founder and Chief Operating Officer at Hone Health, a men's optimization clinic that offers at-home blood tests, tele-health consultations, and medication delivery.

Prior to this, Stuart held the position of Chief Business Officer at Seventh Sense Biosystems (now YourBioHealth), where they played a key role in designing and developing the world's first push-button blood collection device. Before that, they worked at AgaMatrix, where they served as the Executive Director of Business Development and Strategy, as well as the Director of Worldwide Commercial Development.

Stuart's experience spans over several years and includes a focus on improving healthcare systems and providing convenient solutions for consumers.

Check out the episode on Spotify, iTunes, or YouTube

If you’ve been forwarded this email and are just getting this for the first time— thanks for reading! I publish podcasts monthly and I’d love for you to subscribe using the link below.

Video Version

[1:00] Stuart’s origin in HealthTech, and how he created the first-ever medical device for the original iPhone

  • Started his career and joined two founders who started AgaMatrix in the diabetes space

  • He had done Biomedical Engineering in college at Johns Hopkins, and he was sort of the “black sheep” there because people didn’t want to go to health startups in 2002, but rather medical school or government or research

  • AgaMatrix made glucometers with test strips for diabetes and then launched a medical device company

  • They ended up getting to retail pharmacies, and 15 years later the device that they made is still on the shelves at CVS, Krogers, etc.

  • They started working with Apple in 2007, right around the release of the first iPhone, to create a smart glucometer which was cleared by the FDA

  • They were able to partner with Sanofi, and distributed their product in 20-30 countries

How I’m imagining Stuart felt at Johns Hopkins

[4:22] Why he decided to stay at AgaMatrix for 10+ years

  • Every 2-3 years, he did something new, so it didn’t feel like that long

  • The first couple years were core startup mode to figure out product-market fit and raise capital.

  • The first idea was to make software to make glucometers work better. This was a stupid idea because people make money on the glucose test strips and not the glucometer themselves

  • The next few years were about growing and selling, and they signed a bunch of deals to distribute their products. One was Liberty Medical, which provided products to people on Medicaid

  • The last few years were about distribution, building around new partnerships like the international one with Sanofi and scaling their sales team to get into more patients’ daily routines

[7:07] How did he pivot to SeventhSense Bio?

  • He had a lot of experience in HealthTech and diagnostics, and had met SeventhSense Bio before joining them

  • They had an interesting angle on at-home testing, which would require an easy device to get that blood from the patient without the assistance of a healthcare professional

  • Met many founders (ex. Hims, Romans, and also the much-maligned Theranos) and saw the D2C angle for medications

  • Key insight was they haven’t gotten to mass adoption because of cost angle, usability angle, and lab compatibility angle

  • Most important is the usability angle, because at-home diagnostic has to function 99% of the time, the first time (there are no “re-dos” because it isn’t like the patient has another tube or a professional to help them at home). The devices that are on the market right now aren’t there yet, but might get there

  • His thesis was that there are going to be way more D2C, cash-pay, access companies started but they’re going to get started around high-niche customers who aren’t getting serviced already by the system

[11:39] Founding Hone Health

  • He met his current co-founder, Saad, and liked his story. Saad had turned 35 and he had all the symptoms of Low Testosterone (Low T)

  • Saad approached Stuart in his role at SeventhSense Bio and thought that his at-home device could help measure low T in his customers

  • Stuart said it might not work that way, but he was intrigued by the business model and decided to join Saad at Hone Health 4 years ago

[13:23] What does he think was core to build Hone?

  • Shree’s take: With D2C companies, I see three issues — the patient needs to know that they have the disease, they need to know where to go to treat it, and they need to make sure that the provider also knows how to treat this under-serviced condition

  • Something that was core to the offering that they built was through building their physician network. A lot of HealthTech companies would use Wheel or SteadyMD provider networks to get started, but the specialty care that Hone provides prevented them from doing this

  • Stuart can tell if the physician is knowledgable about treatment for male hormonal health in 1 minute — do they (1) know the patient population, (2) do they know the protocols around dosing testosterone, (3) are they committed to the clinic by responding frequently / giving this the seriousness that it deserves, (4) can you use technology well to treat patients, and (5) do they pass the vibe check. Below is a video of his real time reaction when a doctor says they don’t know the correct dosing of testosterone

  • Hone’s business model is that a physician meets with a patient after they get labs via a tele-medicine consult, and then they determine based on AUA guidelines whether a patient needs to get low T. Then, the patient gets on a subscription plan to pay for the treatment and has a consult every 90 days

[21:54] Risks to Hone’s business model by using telemedicine with controlled substances

  • Context: The Ryan Haight law prevents providers from using telehealth from prescribing controlled substances. It was temporarily waived during the pandemic, when people needed them to continue on treatment (think Suboxone for opioid dependance, or Testosterone like in this case)

  • Stuart doesn’t think it will be a big risk because the law originally was meant to prevent people from googling “Vicodin” to buy it online. This law came out 15 years ago when telemedicine was far from prevalent

  • The DEA had a proposal (summarized by Stuart) that said that a patient should see a provider in person at least once in 90 days to continue on that prescription for the controlled substance. Hone’s patient population would be OK seeing a practitioner, Stuart thinks, because they go to LabCorp every 90 days for a lab test to continue being on Testosterone

  • The DEA held sessions in September 2023 to learn more about what to do about this restriction, and they decided to make a special registration process to make sure that providers could be able to continue to prescribe controlled substances via a telemedicine pathway which (he thinks) will be finished by the end of next year (2024)

[27:11] Surprising things that Stuart learned about the patient population at Hone

  • Patients want options, it’s not about either getting labs taken at-home or in the clinic, but it’s the option of getting it at one or the other. You could have a patient in a city who has LabCorp 10 minutes away from them, or a rural area where they have one 150 miles away

[29:01] Hone Health’s Unit Economics

  • Stuart thinks that Unit Economics have to work from day one, and that VC-backed companies cannot stay afloat if this basic tenet is not met because simply relying on growth will not outpace profitability

  • They want to expand to longevity, thyroid care, obesity, etc. Right now, they don’t serve that and their providers will send them elsewhere to get that care

[31:20] Stuart’s hot takes on Twitter

  • Stuart thinks that there are many players in the space who are making money off of the “bad things” that are happening in healthcare. If you insert X thing here, and you ask “why isn’t anyone disrupting this? It’s terrible for patients,” there’s probably someone profiting off of that

  • Hone Health might have some competition as more clinics pop up, and there is a “race to the bottom” as they compete on pricing, but they can compete on the value that they provide to the consumer

  • One of the key learnings that they had on Hone Health was that in order to keep OpEx low, they have to be scrappy. Stuart mentioned if you’re starting out, just “use Google Sheets.” Then you can figure out how to get your first customers, and then build from there

  • Those learnings are very critical and they can serve the business

[38:53] Building their own HIPAA compliant EMR

  • They are not serving a population which requires Meaningful Use metrics (i.e., Medicare), since they are out-of-pocket / cash pay for all of their costs, but if they were then they will add on compliance after the fact

  • They first got one off-the-shelf, but it was pretty bad and wasn’t helpful. The off-the-shelf EMR was fine for doctors who were writing notes, but the problems came in from a product standpoint, where there weren’t meaningful ways to onboard patients and have a good patient journey

  • This was complemented because each of the founders had their own expertise, so they were able to build a better company by having a lot of synergies (marketing, finance, ops, marketing, brand, etc.)

[43:48] Stuart’s vision for the future of Hone Health

  • At a minimum, they want to be able to network with payers. They want to reduce out-of-pocket costs for patients, and they want to expand the amount of benefits which they can tackle using Hone (i.e., longevity, etc.)

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