Innovation Diffusion: Newtopia CEO Jeff Ruby on Genetic Testing & Personalized Disease Prevention

N=1. That’s what the future of healthcare looks like with Newtopia’s hyper personalized approach to disease prevention. The health engagement startup is on a mission to inspire at-risk individuals to make the right lifestyle choices to lead healthier lives. Results of a randomized control trial with Aetna, published in the Journal of Occupational and Environmental Medicine, show they are on to something. The Newtopia solution, which uses genetic testing to create personalized disease prevention programs, led to a $122 per participant per month savings and a positive return on investment in the program’s first year. Oliver Wyman Associate Terrance Wallace talked with Newtopia founder and CEO Jeff Ruby to learn more about what it took to achieve this milestone:

Terrance Wallace: I imagine there are still a few people out there who haven’t heard the Newtopia story. Could you give us an overview?

Jeff Ruby: The Newtopia story is a very personal one. I began innovating in the health space about 15 years ago when I learned that my father was diagnosed with abdominal cancer. That was my first rude introduction to what I now call our sick care system. Prior to that I had no occasion to look at health or be involved in it. It was through my dad’s experience that I really came to learn two lessons, which have now driven 15 years and 4 startups. First, I learned that fundamentally we don’t offer ‘healthcare’ in the truest sense of the word. I think what we offer is functioning sick care that kicks in when something is wrong with us. By and large, what most of us do is hop from one foot to the next guessing wildly at what to do until inevitably - and seemingly randomly - we bang into the sick care system. For my dad that was 54, for others it’s well into older age, for others it’s in their youth. The randomness of that seemed weird to me, and I wanted to understand it more. The second insight came to me sitting in the oncologist office. The first question out of my dad’s mouth after his diagnosis was ‘Doctor, how did I get this?’ The oncologist came back with ‘Well Mr. Ruby, I think a lot of this has to do with some unlucky genetics and your lifestyle choices.’ I was struck by that answer because at the time I didn’t understand that your genes and lifestyle choices could lead to cancer, and I had to believe that many others didn’t understand this connection either. At that point, I became very passionate about figuring out how we can arm people with the right information to make good lifestyle decisions and also how we can engage people by understanding their genes to really activate that lifestyle plan. I wanted to engage people in real healthcare so they could stay healthy and stay out of the sick care system. That’s the Newtopia story. What I do every day is wake up trying to create a platform that had my dad had it in his life, I believe he’d still be here.

TW: How have you refined your mission?

JR: Our current mission is to help individuals at risk of developing a chronic disease. We help those that have moved a little bit beyond just the couple of extra pounds and some unhealthy decisions; it’s the people who are now sitting at the edge of clinical obesity, or diabetes, or heart disease, or stroke. We want to really inspire those individuals by understanding them. We motivate them to live healthy each and every day and make the lifestyle choices to reduce that risk. If we do our job well, then we will reduce the incidence of obesity, diabetes, heart disease, and stroke around the world.

TW: Newtopia isn't your typical engagement or decision support platform. How are you different?

JR: Fundamentally this comes down to our belief system that the answer to sustainable behavior change lies within each individual—and it’s unique to each individual. You just have to take the time to understand each individual, and then based on that understanding shape a hyper personalized experience that will ultimately mean something and be of value to that individual. We’re talking about n=1, one size fits one engagement in care approach. That’s what differentiates us. I’ll add that sustainable lifestyle change doesn’t come out of fear. Fear is a great motivator for short-term goals, same as extrinsic motivators like rewards points and dollars. But sustainable behavior change comes from a sense of control, a sense of inspiration, and tapping into someone’s intrinsic motivations to change.

TW: Can you take us behind the scenes at Newtopia and share more about how this works?

JR: We’re leveraging personal genetic testing, which is quite unique, but we’re leveraging it as a genetic engagement company. The genetic testing isn’t to help the individual understand their risk factors, which are determined through biometric testing or a CDC-based screening assessment. The genetic testing is primarily used as an engagement tool to educate the individual at risk on whether they may have inherited some factors that may affect, for example, their weight. This helps them to stop blaming themselves and understand that there is some biology at play, and also gives them a sense of control over the outcome. That sense of control over the outcome comes by making genetically driven lifestyle recommendations. Each of the genes that we evaluate gives us macro information about recommendations we’re making in nutrition, activity, and behavior management. So we are driving a genetically driven prescription that moves beyond a generic guideline to an approach that is driven from the person and for the person. The genetic information, taken together with some very specific behavioral profiling, helps us develop the right lifestyle prescription for each individual and determine how best to deliver the content to each person, who should deliver it to each person, how to gamify it, and how to make it social.  That interplay of engagement is what drives our industry leading outcomes.

TW: Tell us about the significance of the RCT results from your partnership with Aetna.

JR: We’ve gone with a very distinct strategy of wanting to have gold-standard data and evidence to commercialize with. We made a decision to partner with Aetna on this RCT. It’s a 3-year RCT; we’ve just published the first 12 months. By my understanding, we will have the longest RCT data for this type of disease prevention. The Aetna RCT demonstrates that we have achieved strong registration and engagement outcomes: 32% registered and 50% engaged over 12 months. Those are unheard of numbers in the industry. That has translated into significant clinical impact, reductions in major metabolic syndrome risk factors, and that all important end-of-year cost savings of $1464 per participant, which delivers an in-year payback and ROI. That is unprecedented for a corporate health or disease prevention program of this kind. That’s a big milestone not only for Newtopia but for the disease prevention industry more broadly. With this new information we are selling alongside Aetna to all of their plan sponsors. We also have our own direct sales team talking with other payers and self-insured employers. We’re using our RCT results as a springboard to commercialize and scale.

TW: What are your immediate goals and challenges?

JR: The immediate goal is to scale and improve upon our outcomes. We’ve built our platform and approach with total scale in mind. We’ve got a target of 10K participants by the end of 2016, jumping to 25K participants by the end of 2017, and over 50K by the end of 2018. We have aggressive growth goals that we want to hit. There are challenges for any growth-stage startup company. For us we set a really high bar in terms of our data and outcomes. As we scale, the challenge will be to maintain and exceed what we demonstrated in the RCT. This only gets better with scale. As we collect more data, we’re able to apply artificial intelligence and machine learning to improve our approach and how we hyper personalize to engage. As we grow, despite the challenges of scale, we should be able to provide even better registration, engagement, clinical, and cost savings outcomes.

TW: As you scale, it will be critically important to continue cultivating the right people and culture to drive such impressive outcomes and engagement levels.

JR: Yes, that’s a great point. The foundation of Newtopia is an integrated team of experts: dietitians, exercise physiologists, clinical phycologists, medical doctors, naturopathic doctors, pharmacologists, and geneticists. They set the guidelines and understand the research to make sure everything we do is evidence and guideline based. The program delivery comes through our coaches, who we call INSPIRATORS. They have backgrounds in psychology, nutrition, or kinesiology. They then go through an intensive integrated content and behavioral training program that we’ve developed. We also test them against a key behavioral profile that we’ve identified. What we then do is personality match each INSPIRATOR to each participant. Think E-Harmony for each INSPIRATOR and participant. What we’re essentially doing is creating the best fit possible from a personality and motivation perspective to achieve best results.

TW: What does the future of healthcare look like to you?

JR: Simple answer is n=1. The future of healthcare will be hyper personalized. It’s all about moving away from one size fits all. We’re seeing it in the pharma industry with a move away from blockbuster drugs to personalized medicine. We are the pioneer for the precision health movement, which is really shaping the course of health truly based on an individual’s genetics, behavior, and personality. I would say hyper personalized care where n=1 is the future. I’d also say it’s preventative. For too long, we’ve been focused and buried under the cost of sick care. It’s far less expensive to identify issues early and prevent issues from beginning in the first place.

TW: What about corporate health. Do you see any trends factoring into the evolution of that segment?

JR: There has been a move away from what I see as a two-part approach to corporate health. Traditionally on the far left, you have had corporate wellness programs which are very popular as of late. Those are really addressing the healthy and the at-risk employees. On the far right, you have disease or condition management for those that are sick. Newtopia is playing a part in creating a third tier in the middle. This is the disease prevention approach. We’ve created a solution for that at-risk segment who are neither healthy nor sick.  In our case, the at-risk segment is 50% of the employee audience. Those individuals need something more than the one-size-fits-all strategy where you give them a Fitbit and a 10,000 step wellness challenge. On the other hand, they don’t have access to condition or disease management since they are not sick. A focus on disease prevention for at-risk employees is an area that I think is going to grow.  We’ve found that this group of employees require more intensive engagement than the traditional wellness program, but also have a greater degree of motivation to make a change.  As we’ve demonstrated, there is also great economic rationale for putting focus there. This doesn’t mean not focusing on the other segments, but adding this third tier is really important.

TW: Something that Newtopia does uniquely, but that doesn’t get much airtime is precision medicine. What are your thoughts on the importance of the genetic engagement concept?

JR: President Obama’s precision medicine initiative gave a big spotlight to personalized medicine and the use of genetic testing to tailor clinical treatments. I think what gets a little bit lost is the power of genetic information to engage. It’s important to note that the information doesn’t have to be disease specific, in fact the less disease specific the better. There’s more of a desire to understand one’s self and the forces within our body that may be contributing to things that we don’t like or have little control over. Knowing this information is a very powerful engagement hook and a very powerful sense of control that’s necessary to change behavior. This is something that I think is overlooked an awful lot when the discussion of genetic testing comes up. This is an area that we have recognized and are harnessing to drive the kind of outcomes that we do.

TW: What advice do you have for other startup leaders?

JR: I would certainly say that you’ve got to start with passion and grow with outcomes. Startups are challenging and unpredictable, so if there’s not an underlying passion to serve as the fuel during the ups and downs and pivots, then this can become immensely challenging to do well – especially in health. The next is that you’ve got to prove that your solution works and that has to be based on data. Just saying or believing your concept works or having fund raising rounds or fancy boards of directors won’t get you far. Being able to prove your concept scientifically and answer questions about it while being open to scrutiny can lead to success. So you’ve got to be open to proving your outcomes because data and outcomes are king. Lastly, it’s also very important to go out and find the innovators to partner with. Finding organizations that are looking for innovation and are built for it is important to have in mind. I would characterize our relationship with Aetna this way. They have established an innovation group and an innovation framework to evaluate groups like us. By no means did they give us an easy pass.  Rather,they established a framework for evaluating innovative solutions and testing them to prove whether they work or not. That’s made a huge difference for me and will be very important to others undertaking this journey.