Yusuf Sherwani , Quit Genius

Episode Summary

Yusuf Sherwani saw the value in remote mental healthcare long before COVID sent everyone into video therapy sessions. He is the CEO and one of three doctor/co-founders of Quit Genius, an app that uses CBT therapy and other proven methods to help patients tackle their addiction. He talks with Darrell and Jordan about starting a telehealth company before COVID and the regulatory hurdles they had to navigate and how they convinced investors that it was crucial to be research-led when it comes to building a patient-focused product.

Episode Notes

Yusuf Sherwani saw the value in remote mental healthcare long before COVID sent everyone into video therapy sessions. He is the CEO and one of three doctor/co-founders of Quit Genius, an app that uses CBT therapy and other proven methods to help patients tackle their addiction. He talks with Darrell and Jordan about starting a telehealth company before COVID and the regulatory hurdles they had to navigate and how they convinced investors that it was crucial to be research-led when it comes to building a patient-focused product.

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Episode Transcription

Darrell Etherington  0:00  

Hi I'm Darrell Etherington host of found you know, TechCrunch his podcast where we talk about different found every week. And guess what? I have to quit to my genius. Wait.


Jordan Crook  0:13  



Darrell Etherington  0:15  

the other way around. Yeah, cuz you're not a squid. So I'm the genius. You always.


Jordan Crook  0:23  

I'm not a genius. Neither. But yeah, I'm here, whatever I'm here doing best


Darrell Etherington  0:30  

right? I'm glad you're here. This week I just put the joke as the as the name of the company. That's the first time I've done that it's a record. The company this week is quit genius. And the founder is Yousef Sherwani, who is also a medical doctor, which I didn't learn on the show, but I forgotten and then he reminded us in the show, and then I was like, oh, yeah, that's so cool relearned on how we learned on the show.


Jordan Crook  0:53  

Thank God you're not the doctor, right would hate to have you relearning things while you're performing procedures on me or something? Like if I forgot I was a doctor. You mean and then? No, like, if you forgot, like, what the name of my disease was, or


Darrell Etherington  1:05  

whatever? Oh, yeah, I mean, that sounds like actually a pretty good pitch for like a for like a medical drama TV like an hour long CBS


Jordan Crook  1:14  

show or something, forgetful doctor,


Darrell Etherington  1:17  

here or there. Anyways, our show this week is all about use of how he started quit genius and why he did it and how the company operates and why the company operates the way it does. And we get really into a lot of the theory around kind of like remote care, virtual care, and also accessibility of care and accessibility to treatments for quitting substance addiction, including cognitive behavioral therapy treatments. CBT, which were not generally available, like the people who are trained and the proper practitioner of that where they are located didn't necessarily line up with where those problems are most severe. So that's one of the reasons quiches came into being. And I think it's something that use have explained really well. So you know, you don't have to hear from me. You don't don't listen to me and my stumbling. Terrible speak listen to


Jordan Crook  2:13  

you can go ahead and edit this out. Let's just skip to the Yeah, absolutely.


Darrell Etherington  2:17  

I will get into it. I used to how's it going,


Yusuf Sherwani  2:24  

man, I'm well, thanks, Darrell. How are you? Good. Good.


Darrell Etherington  2:27  

Great to have you here. Really excited to hear more about your company quit genius. And a little bit about you know, your your journey in starting that. But do you want to give us just kind of a TLDR? Or a high level overview of what quit genius is?


Yusuf Sherwani  2:43  

Yeah, absolutely. So quick genius is the leading digital clinic for substance addictions. So we help individuals conquer their addictions. And in doing so to help payers reduce some of the costs associated with actually treating those addictions. If this spiral out of control your high level, how we do it is through a combination of telehealth connected devices, access to digital cognitive behavioral therapy, and medication management is really a holistic clinic, the type you would expect to experience if you visited a clinic in person, but delivered entirely digitally on your own terms.


Darrell Etherington  3:16  

When you started. This was probably what four years ago? Is that right? So I have it right.


Yusuf Sherwani  3:20  

Exactly. Fair enough. Yeah, I think Jordan covered our Wi Fi launch. Pretty


Jordan Crook  3:25  

early. Oh, nice. Yeah, I've covered a couple of things. Right. A couple raises and stuff.


Yusuf Sherwani  3:29  

Yeah, like the launch party series. A Yeah, definitely been part of the journey, who


Darrell Etherington  3:34  

we now at TechCrunch, we see a fair amount of like digital therapy companies coming through and digital therapy startups coming through. But I think at the time, it was like a relatively new, I mean, it's still relatively new term, but it was probably something that many people had heard of. So what kind of like got you started in this as a vector for the delivery of specifically quitting assistance and cessation, AIDS and things like that?


Yusuf Sherwani  3:59  

Yeah, I think that's a great question. I had to be on this because back then digital health definitely wasn't as sexy as it is now. And, you know, we had real challenges starting out. I mean, you know, we were first time founders, of course, but just raising offers, check, getting investor interest, getting people excited about the fact that, hey, we want to help people quit smoking, and then eventually we want to move over to, you know, alcohol and alcohol use disorder, and you know, the opioid epidemic, it just wasn't like a fun place to be digital was often where you would see incredibly low, long sales cycles, death by pilots was, you know, a common refrain. So the question was, like, can you really monetize something like this in the long term? was a real question that we had. I definitely say that, you know, it's been a real journey, building the business over the last few years. COVID In many ways, has been a tailwind to the business, not just because, you know, we saw a tremendous increase in the prevalence of substance addiction. So, you know, turned out that a combination of the fear and anxiety and isolation that people faced over The last 18 months lead to some of the most rapid acceleration that we've actually seen for substance use disorders broadly across the spectrum. But in addition to that, there's also just a widespread acceptance that virtual care is a very real option. So it turned from being a nice to have, which is what it was before, where you really had to educate your customers in the market that virtual can be just as effective, as you know, in person treatment to suddenly being a must have overnight almost like a critical piece of infrastructure that, you know, healthcare system can't survive with, without so think early days, what sort of certain set us up for long term success, but also initially helps us overcome some of the sort of potential cynicism of the model was really focusing on building a clinical evidence a showing that people were willing to accept this. And actually, the outcomes would be just as good if not better, by having somebody go through a virtual care program, and there would be for somebody going through an in person program. So I think that was the very first litmus test. And, frankly, we spent the first couple of years just really focusing on proving, you know, great outcomes and a great member experience and the fact that this could actually help people overcome their addiction, much in the same way that seeing a therapist in real life would be able to do the same.


Jordan Crook  6:11  

Can you talk a little bit you sort of about, like, how cognitive behavioral therapy comes into play as part of it, right? Because quick genius is pretty much built on that. And it's been around for decades, but really seems to be picking up steam lately, you know, where did it come into play for you guys, when you were thinking, Okay, we do have to prove the clinical outcomes of this. And then why do you think it's having kind of such a big momentum swing in the past five or so years versus other forms of therapy?


Yusuf Sherwani  6:38  

Yeah, I think that's a great question. And in many ways, that goes into the reasons that we had for founding quite genius in the first place. So by background, you know, I'm a medical doctor. And quick genius was really an idea that sort of came about during medical school, my co founders and I, we went to medical school together. And one of the things we saw through personal experiences that I had, within my own family, where I saw people struggling with an addiction, was the recognition that for some reason, more than 92% of people with an addiction today never get access to evidence based treatment. So we have these therapies that exist in the real world, things like cognitive behavioral therapy, and medication management. But also, almost nobody is actually using that in the first place. And that was really interesting for us, because I was seeing this sort of personal data where you're taught this version of healthcare, in medical school, that you're supposed to be very holistic, you're supposed to help people with a psychological component, as well as the physical component of whatever situation they're managing. But you know, in actual fact, we do very little of that. And instead, you take a band aid approach. And I think the reason for that is, despite CBT being incredibly effective, the challenge is access. And it's about being able to standardize a high quality of care. So first of all, they're often on enough providers. But more importantly, they're not having enough providers, those providers aren't in the same locality as people that actually have an addiction in the first place. And you see this when you look at the headlines, where there's a really, you know, a really big rural problem when it applies to an addiction. So, you know, all the providers are typically, and this is an oversimplification, but all the providers are in big cities, people in rural areas just don't get access to evidence based treatment. And as a result, there's a mismatch of supply and demand. And that's not like something that technology could solve. In addition to that, there's no real way to standardize care. So today, it's a cottage industry, everybody delivers a slightly different flavor of CBT. And there's new tools that really enable us to see what's effectively working for one provider that we can potentially apply to another provider. So we thought that both of those things could actually be solved super effectively using technology. But it really comes down to rethinking how these traditional tools could be made more effective for the 21st century. So, you know, we know CBT is incredibly effective in the real world. But can we reimagine it in a way that it doesn't have to be a one hour consultation with a therapist once a week, but it can be a few minutes, every day. And you know, it could be delivered through, you know, multiple different modalities, or it can be delivered over text, it could be delivered over voice and video at the same time in a way that suits that specific individual thing that's like, broadly speaking, the challenge of why it hasn't sort of been as widely available as it has before. But how technology can solve some of those challenges for you


Darrell Etherington  9:17  

in those early days? What was your method for convincing people? Like this is an effective method, and we can show you that it is and were the conversations with VCs in particular difficult around that. And how did you kind of overcome that?


Yusuf Sherwani  9:31  

Yeah, I think it's actually sort of there's two problems that we're facing early on. So one was convincing customers, and that is to say payers, specifically who we were selling to that virtual care is a very real way to solve an old problem. So if you come to them and you say, Hey, we can help solve all your addiction challenges. That sounds great. In many ways, that sounds almost too good to be true, because these are, you know, really deep systemic issues in society. And we're not saying we can solve every We think there's social determinants of health, there's so many different factors, but we can certainly make a big dent in that. But it requires us to really present the data on how our virtual care model is going to be effective for their population. So, you know, what we found to be effective for for those customers was just data, clinical data, we went all out. And we did a randomized control trial, which was typically, you know, what you would have a drug or a vaccine, you know, Plaid COVID, you know, vaccines go through that process. So you're really assessing within a population, if you're given sort of face to face therapy, and virtual care, that is quick genius, you know, we'll find the quick genius to be much more effective even than face to face therapy, because you could get it on your own terms, it's faster, you can get real time feedback, you can get a whole host of tools around you. So we found the data piece was very effective, then we went to VCs, and they couldn't understand why we were spending so much on clinical research. So early on in our company's lifecycle, before we were even generating any revenue. I mean, that's again, an oversimplification. So I'd say VCs sell into two counts, there were the VCs that ultimately did invest in us, that saw the value in that because they knew healthcare and health tech and digital health was a little bit different. And you want to take, you know, a much more nuanced approach, and you want to make sure what you're putting in front of members is going to be effective. And but then there was the more sort of tech enabled VC where they were like, you know, you just need to go to market, you just need to sell it, you can sort of figure it out and build it as you're selling it. And it just showed a mismatch in expectations for something that is fundamentally helping, you know, profoundly affecting people's lives, and you need to go to those discussions with a lot of validated data behind it. So we found that very challenging, ultimately, it is a chicken in the egg situation, and we're able to raise enough capital, and, you know, be resourceful enough to do this clinical studies on on a shoestring budget, and then enable that to then go to payers get adoption and get that ball rolling for you


Darrell Etherington  11:51  

as a person coming from medical background. Were you expecting that tech perspective? Or did you kind of assume people would understand the importance of doing that research first, even even if they were relatively naive in the subject matter? Or what like, was it to you, like shocking to hear people be like, just just keep going, just get it out there? Just see how it goes?


Yusuf Sherwani  12:13  

Yeah, I think it definitely was quite surprising, I think you, you need to learn to speak the language. So I think, you know, perhaps the failing was more in the way we presented that, and laying out a clear vision for how this piece of clinical research actually has a very higher ROI. And it's table stakes, but not just table stakes is like, you know, moat around the business. So that's defensible, it's something that when you have a randomized control trial, it doesn't matter, you no matter how much capital you have, it just takes a certain amount of time, as we've seen to get that approved. And, you know, to get all the data surrounding that. So I think, yeah, it was a bit of a, you know, a shock to the system, we have to figure out how to convey it in language, you know, terms that made sense to the people that would invest in the business, ultimately, we got a great set of investors that actually understood the value in that, and oftentimes had already seen that sort of play out in other areas as well. So there are a lot more understanding and, you know, warm to the idea.


Darrell Etherington  13:09  

I also wanted to talk about just from reading your own writing about like you, you had this hypothesis that like the naive founder is good, right? Like it has potential to be more successful than one who is perhaps more knowledgeable about the ways things work or are supposed to work, right. And you also talked about like how, you know, you, you sympathize or empathize with the perspective that like, as a founder, now looking back, like, you wouldn't necessarily want to go do it again, knowing what you know now about how difficult it is, I'm wondering, like, how much is that true for you? Like, if you're looking back and thinking like, Oh, my goodness, like, the challenges for me were immense compared to what I expected they were going to be like, especially for other founders, who are maybe in a similar position, like, how do you kind of mirror yourself against that? Or is it bad to? And should you just go in with a kind of naive perspective, because it's better to not know what's coming for you?


Yusuf Sherwani  14:02  

Yeah, I think that's yeah, definitely one of these articles. That's probably the conclusion of too much introspection and reflection, in many ways. But yeah, I think that actually, there's a lot of truth to that, which is, oftentimes, particularly first time founders, you sort of jump into things without truly knowing all the implications of that. And I know for sure that we had no idea how challenging it would be to, you know, create a digital health business that's focused on an enterprise sales go to market. So you know, our naive approach was, hey, CBT is incredibly effective in the real world. Medication management is really incredibly, you know, effective in the real world. These things aren't available to actual patients. Why don't we just build a product that makes this available? And then it's going to be simple, everybody's going to want to buy it. And, you know, the reality was just so far from that we realize that we need to raise money people aren't necessarily willing to invest in a company that doesn't have real traction. So you've also got to do the clinical research. On top of that, you're doing sort of the clinical research, you're building the product, you're talking to customers, you're signing customers, and then you start to realize that there's this entire other world, when it comes to, you know, regulations, and you know, what you're allowed to do, and in which state, you're allowed to do it. And unfortunately, the system that exists today just didn't contemplate telehealth as a way we think about licensing medical professionals, you know, across multiple states, and this has been, you know, covered before in the past, just didn't contemplate the fact that providers will one day be able to just jump on a call or jump in a video consultation with somebody that might be 1000 miles apart. And the fundamental biology of that individual in California isn't going to be any different to somebody in New York, or somebody in Chicago. But the complexity that exists from an operation standpoint, and actually getting folks licensed based on the counseling side, as well as the physician, you know, medical side is just enormous and maintaining that licensing, maintaining compliance across states. There's this enormous overhead that, you know, unfortunately exists today. And I think that those were the types of more pragmatic challenges that we just didn't contemplate early on. And frankly, you're right. Like I said, In the article, if we knew, if somebody came to us and said, Okay, here's the 50, things you haven't thought about with your idea, I probably would have said, you know, what, then we try thinking about something a bit simple that I can actually do first company. But I mean, like any problems, if you just break it down to its constituent parts, one at a time problem solve them, then that progress compounds over time, and you can actually make great progress and actually build something that's truly novel. So, you know, in hindsight, it wouldn't change anything. But it definitely was a big wake up call as we started to face some of these challenges.


Darrell Etherington  16:47  

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Yusuf Sherwani  17:53  

Yeah, so I mean, going back a few steps, actually, in many ways, I didn't actually expect to find myself in medical school in the first place. So I had a pretty conventional sort of childhood for somebody that's now working in tech. So I grew up coding, you know, loved computers, self taught programming, in my early teens started my first business, actually at the age of 14. And then I sold that, by chance, a couple of years later. So in many ways, I saw myself, you know, just going down, I mean, I sort of grew up reading TechCrunch, actually, and remember, the mike Harrington days, and you know, was always inspired to build my, you know, to build my own company eventually. But maybe through, you know, my actual upbringing and sort of the values that my parents gave to me, I also found it somewhat difficult to reconcile how I could do that with, you know, achieving something that was actually beneficial to society. And my mother was Doctor, so they really drummed into me that like idea of like service to something that's bigger than yourself. And I always thought as technology of technology as being this totally separate thing, to working on something that's actually meaningful, that could have, you know, a positive impact on people. And in many ways, I think that's quite interesting. Because there has been this growing skepticism, we've seen off technology in the last sort of decade or so. So I ended up going to medical school, mainly because I felt that, okay, I can teach myself to code and that can maintain that interest. But I can't teach myself to be a doctor. And you probably don't want to go to a self taught doctor. So that's not going to be something that actually ends well. And then during medical school, I had a close family member go through an addiction challenge, and actually, that family member ended up passing away, and it was likely linked to the challenge they had. And that started, you know, getting me thinking actually, like, why are we you know, treating chronic conditions? Why are we treating stigmatized issues in the way we all win, we know that there are very valid therapies that exist in the real world. And in the early days of quick genius actually wasn't a startup. We created it as a proof of concept. And we actually published our findings in a paper and presented at an academic conference. And we're like, you know, we said, here's the proof of concept. Here's what people should take forward. Somebody should go out and build this thing. And then we sort of realized that actually, nobody's going to do that, and in the academic world, or probably sit on a dusty shelf, and we'll just go and have, you know, a clinical career, as you know, as a doctor should. And that's where we went through that, I guess, process of recognizing that actually, if we really want to have meaningful impact, and be able to scale that impact millions of people, being able to marry the technology world with evidence based medicine, and stay grounded with one foot in either domain is probably the more meaningful thing. And you know, through that, we actually became a lot more passionate about mission driven technology, it's about doing something that goes beyond just your specific customers, or your employees or your investors, but has sort of lasting positive impact on people.


Darrell Etherington  20:42  

It's not hard to turn tech to the purpose of social impact. And I think there's plenty of opportunities like yours, where it's just there. And it's a matter of connecting the components that are there, and also having grit to go through the stuff like the regulation several you mentioned, right? But like, I just I find it funny that not as many founders look in that direction, but maybe you're you get at it by talking about how like you used to think of them as sort of isolated things. But how do you think about that now? Or do you think about that now? Like, is there a way to encourage more founders to consider that aspect of the business? And? And what's your advice? I guess, there?


Yusuf Sherwani  21:20  

Yeah, I think that's a great question. And I do spend a bit of time thinking about it, and actually do fundamentally believe that more and more people are going into technology to be mission driven. And they want to make mission, you know, the core of what they do. So they have a worldview, you know, all things, and whether it's climate, or healthcare, or other societal challenges we face like people really want to make that central to their, you know, fundamental company, and hire to the actual business model. And I think that's great. And actually also fundamentally think that mission driven companies are just much more likely to be successful. Because today, the real challenge that every company faces we really face is just, you know, hiring very, very talented people. So startups are incredibly hard, they take a very long time, they vary, they take a very consistently intense effort. And without some sort of shared sense of mission, through the downs, to really drive people, it's just very easy for people to potentially give up. And, you know, being mission driven, is really our number one recruiting line that we use for people. So I do think that talented people do want to work on something generally, that has a beneficial impact on society, and being able to actually, you know, say that this is aligned to the business model of our organization. And every line of code that you write every deal that you close, every client that you make happy through the account management team, that's going to lead to some measurable overall impact is incredibly powerful. And we're seeing more of that actually happen. And they talk more and more founders who are thinking about that from the very earliest stages, which I think is really nice. And, you know, starts to show how tech can not sort of become that parallel track with, you know, working on something purposeful, but actually, there's ways for this to merge over time, it's great


Darrell Etherington  23:09  

to think of it as pipeline now requires this as a component, right? Then it's like, even if maybe your idea wasn't that to begin with, or doesn't necessarily have a mission aspect, you have to build a real one in in order to compete in the marketplace for talent, right, which is actually a great message. And not one I've heard sort of like, talked about that much. In tech world.


Yusuf Sherwani  23:31  

Yeah. And I think people have become quite sensitive and can immediately detect those who play like lip service to the idea. So like you said, it's become a bit of a cliche that every startup wants to make the world a better place. But like how? Yeah, then it sort of ends over there. So I do actually think that we're somewhat past that phase, and the ones that truly want to do it, they're able to articulate that from the earliest days. And they're very consistent in that messaging.


Jordan Crook  23:58  

Can you talk to us about like when you decided to add other kind of like verticals to quit genius, because I guess started with just tobacco. And, you know, you hear founders say all the time, like, oh, we just we thought we were going to do 20 things and then we realized we have to do one thing really really well before we move on to thing number two and thing number three, so that the target was about that inflection point for what genius so when you realize like, Okay, we have what we need on this smoking cessation product, like now we can move on to this and kind of height, ordered it and prioritize that. Like I think that's a tricky thing for a lot Bounders


Yusuf Sherwani  24:35  

in a way from the start, we we didn't know that we wanted to be in multiple addictions, but we also knew that we couldn't do that from the start. And because you just digital health just wasn't accepted at the time. We needed to focus on one thing really do it well and prove the model work and then add to that overtime, and that's why we started with tobacco. And we chose tobacco simply because it was the least regulated. So you know, we could use Quick coaches that didn't need to be licensed in specific states that could be broadly utilized across any state. And because smoking is seen as more of a wellness issue, there wouldn't be any risk of you know, require it or requiring qualified medical professionals, or medical device licensing to be able to launch a program in the first place. But fundamentally, all addictions are the same, they have the physical component and the psychological component. So we felt a fairly high level of conviction that if we were successful with smoking, we could, with some adaptations to the underlying platform, apply it in other areas as well, we're pretty intentional in other areas that we started to consider. So this was about, you know, 18 months ago is just before COVID. In fact, we, you know, we'd found that we've done RCT, it was very successful, we're starting to get real commercial traction, and scaling the, you know, the tobacco program to commercial clients. So then came the question of what's next. And what we identified actually, was that about 70% of people who drink heavily, are also smoking. And oftentimes, you know, they're co morbid. So we, you know, we found from our own data, that we weren't as successful, helping people quit smoking, who were also drinking really heavily because the underlying disorder wasn't actually being treated. And this goes to one of the challenges in healthcare today, which is, you know, unfortunately, things are very siloed. So there's a different programs available to you if you're a smoker, but if you drink too much, then you'll have a different program. And maybe you'll have an EAP, or some kind of help and resources available to you if you have an opioid use disorder. But the reality is humans are just really complicated beings. And our data typically shows that more than 1/3 of people that have one addiction are likely to also have another addiction. And they by and large, cost the most to actually treat within a population. So you actually need a program that can really cross the continuum of addiction care across multiple addictions, to have a fighting chance and actually helping some of the most effective people. And so that's where it became pretty clear that for us to do a really good job in tobacco use, we would also need to have a program across the most prevalent and expensive other addiction verticals. But we also wanted to remain focus. So we don't necessarily want to go out there and launch that of a weight loss program next year, or muscular skeletal program, all in the name of having this really holistic, comprehensive solution. We've recognized that actually, substance use disorders are some of the most challenging things we face. They're all very interlinked. And it makes sense to have one overall umbrella program that irrespective of the individual's addiction, or combination of addictions, can be highly personalized towards helping that person in a really dynamic way. So it's just, you know, it feels like something that was built for them personally.


Jordan Crook  27:37  

What about like, the switch over to enterprise, because you talked about this a little bit early on in our conversation, but it feels like a difficult jump to make not just like as a business organizationally and operationally, but it also feels like a difficult sell, right, like to get that first customer on board, because you're essentially saying like, they're probably addicts in your workforce, which I don't think any of us really wants to hear. And then on top of that, it's like, oh, and what I'm going to tell you today are, you need to provide a benefit that's going to cost you money to help them. Right. It's, it's just like a difficult one,


Yusuf Sherwani  28:09  

you're totally correct. It was including credibly challenging. And I guess like, you know, to the point of naivety it on you, we didn't really think through the business model and the reimbursement model, and we set out to build quit genius. So we said, hey, you know, we'll build a great product, we'll build an excellent member experience, and someone will probably pay for it, maybe the user will pay for it. And you know, we'll just sort of figure it out on the back end. And yeah, that, in hindsight, just didn't make a lot of sense. So what we found early on is, you know, we tried a direct consumer model, and we're getting incredible engagement, we're having really successful outcomes, but we just found people weren't willing to pay for it, like we were reaching the ceiling when we're trying to scale the consumer business. And we were sort of delving a bit deeper into that. And every time we went a bit deeper, you know, we'd find that people would say, Well, I'm usually used to somebody else covering the cost of my health care, and you know, pay, you know, into my insurance planning, can I use my HSA for this, or, you know, those types of questions. So, we weren't set up for any of that early on. And that required really rethinking the entire reimbursement model. So we found that, you know, the product by and large, was actually very, very successful, it was very sort of sticky. But people had a ceiling on what they would pay for a digital program that was typically, you know, in the realms of, you know, a meditation app or a wellness app. But the true cost of actually delivering the quick genius program was substantially higher than that. And then enterprise made a lot of sense, because the thinking was, well, who benefits when you get somebody to, you know, overcome and conquer their addiction, whether it's tobacco, alcohol or opioid addiction. And by and large, it's both the individual but it's also the payer. And so the payer stands to gain substantial amount in health care cost savings, if you're able to actually you know, help them sustainably overcome their addiction because there are so many downstream consequences that, you know, you're actually avoiding getting pierced Pay attention, particularly employers early day, you're right, it was incredibly successful. There are questions of Am I a potential liability, because I'm offering this program. And then what if something happens or an incident happened, and we've had incidents before in the past. But I do think actually, generally speaking, employers are some of the most forward thinking people when it comes to health benefits. So that really helped us and helped to build the initial momentum, I think the biggest thing that built initial momentum was actually just being value based. So we were pretty aggressive right out of the door, because we had the clinical data to back it up saying, Hey, we're gonna put 50% of our fees off the bat at risk. And if we don't achieve these clinical outcomes, that's going to correspond to an ROI in your population, you don't have to pay us off the fees. And that was kind of scary to start off with, because it was like, hey, these targets are pretty aggressive, do we think we can reach them, we had a high level of confidence, we could, because we've done the clinical research to back that up. And we've you know, we've never had to actually act on those performance guarantees before in the past, but that instantly grabbed their attention, because it was, hey, we're so used to paying for things on a per employee basis or on a fee for service basis. But if you're truly able to put your money where your mouth is, then maybe this is something we can try out with a pilot, you get that first successful case study. And then like any enterprise sales process, it's just comes down to operationalizing. That, that makes


Darrell Etherington  31:18  

a lot of sense. Because to me, and I always bring this up because I love talking about how Canadian I am. But like, it's weird in the US when the payer system, it's always like, remember that the stakeholders are multiple. And it sounds like you've done a very good job of how do you make sure that the stakeholder who has the purse strings is going to loosen them, but then also be deploying them in the best interest of the true stakeholder or, you know, the receiver of care, right. So like, That, to me is always an another level challenge. That is perhaps the most challenge the the most difficult one the most tricky to untie, when it comes to the healthcare market, right is like, lining those up, especially if you're a mission driven company, and you're a genuine with your desire to achieve those mission results, right? It's like, Okay, remember, I have to take this thing, and I have to deliver it for them and their IRR that they demand. But I also have to make sure that we're actually satisfied or our mission, right and you came in, I think it's great that you came in, initially customer focus, because you never lost sight of that then in that case, right? It's like, in a way coming in with the mistake of like, okay, customer is our primary client ended up being like something that is in the DNA of the company. So your your stakeholder, your care receiver remains a primary client as well. Right. But you say that's true, or I don't know, like, Yeah,


Yusuf Sherwani  32:44  

I think that's a great point, really being member driven, was a value that we didn't articulate in the early days. But that guided everything. And one of the things I actually spend, you know, a lot of time thinking about now with over 100 employees, and so many new joiners every week, is how we maintain that. And that's where, you know, about a year ago, we went through the process of actually codifying what are some of the values that we that that helped us initially be successful early on. And it was really exactly as you described, the recognition that our first and primary customer is always going to be the members that we're actually trying to impact. And, you know, we sort of lay down commitment to the mission to help 100 million people overcome this substance addiction, as being that sort of foundational core value that we're going to go back to and then every sort of decision we make further down the line such as, you know, business model, what actually provides the most amount of value back to our members, does us having skin in the game do that we believe it did, as we continue to scale and, you know, other business decisions over time as well goes back to that, you know, fundamental core value. So I do think that as you start to scale, and you're a mission driven company, really codifying your decision making framework, and how that mission, and helps the guy that when you as a founder on in the room went through and floppy meters is incredibly important,


Darrell Etherington  34:01  

especially with healthcare, I always wonder, as a founder, how much do you think about large structural shifts and changes and trying to encourage those to happen? And how much do you just focus on what do we do within the framework that exists? And how do we just kind of deal with that as it as it is, as opposed to trying to change it right? What's the balance there? And do you ever think about those large structural changes,


Yusuf Sherwani  34:26  

we definitely spend a lot of time thinking about it. And up until relatively recently, our sort of viewpoint has really been that were very small fish in a very large pond. So it's going to always end up being the latter. It's what policy decision is likely. And then let's just figure out how we work within that framework. I do think that there has actually been sort of this growing overall coalition of virtual care and telehealth and digital health companies over the past 18 months that have actually benefited from some of the relaxing and regulations as it applies to state licensing. So one of the things that actually lead to some of the tremendous growth we've seen actually over the last 18 months was the fact that it became possible for, you know, 100% virtual programs like genius to actually exist in areas such as opioid use disorder. So previously to prescribe a controlled substance like Suboxone, which we know is that life saving treatment, and a core part of our program, you needed to have an in person appointment with a patient. And then after that, they, you know, that could happen virtually, that was relaxed. And you know, that the thinking was that there's going to be such widespread abuse, and you're just going to have all these addicts and junkies off the street, kind of figuring out ways of getting access to control substances. None of that really happened. There's no data whatsoever to back that up. And in fact, it really helped to actually remove some of the barriers that existed for accessing care for people with an opioid use disorder. There's a lot of evidence that, you know, telehealth is a great, you know, force multiplier for good. And we should actually figure out a way of making permanent some of the changes that actually happen. We're still in this limbo stage, frankly. But we've been a lot more active as a startup ourselves in lobbying for some of the changes that we think are going to be overall impactful to patients with an addiction. So we're doing more of that. Now. It comes with the caveat that we've also got a plan in the back end for regulations change, how do we interface with existing providers to provide a backup solution as well, but I think it'll be a really sad day because you know, it, the sort of, will very much survive, and we'll be fine. But the result is fewer people are going to be able to easily access telehealth solutions. And we know that without access to care, the outcomes are just going to be worse and the costs are going to continue to escalate.


Darrell Etherington  36:40  

Okay, Jordan, that was our chat with Yousef, another one of the Jordan collection of interesting startup finds growing catalogue,


Jordan Crook  36:49  

right? Yeah, what can I say? I just I, I mean, I pick up and I know how to pick Oh, but pick all the winners. Yeah, I'm Winner picker. I was really happy because I feel like it's been a while since I got to cover quit genius. And they've just like grown so much. And they're in so many different verticals. I feel like I was covering them at the very beginning. And I kind of had a feeling right, we have these like three doctors, and they know what they're talking about on the science side. But their idea to go direct to consumer, I just had this feeling of like, I don't know how many addicts you're going to get to pay to quit doing this thing. They're addicted to right, which


Darrell Etherington  37:28  

ended up they didn't do that. Right. And that ended up not working for them. So you're right about that. They had to go to the payers and get the payers to pay for it. Because as myself a frequent addict. I'm not paying to do that. In fact, one of the things I'm addicted to is paying specifically to indulge my addiction. Yeah.


Jordan Crook  37:46  

Paying for the the thing you're addicted to, and or in your case, addicted to just paying for things. Yes,


Darrell Etherington  37:54  

yes, exactly. We didn't really get into that. Because I think it's for the best, but I like


Jordan Crook  37:59  

to include it in every episode. Yeah, well, no, no,


Darrell Etherington  38:03  

well documented. What's funny about this one is, you know, when we were talking about it, I remembered this is some this is some insider information for you, TechCrunch readers, I remembered when you slap me about this, and we're like, Oh, what do you think like, like probably at the outset? And we're like, what do you think about this? Like they're doing CBT remotely? And I was like, I don't think there's good science and doing CBT. Really, I think you need an in care provider for that. Because it was early. And it was weird. At the time, it was the usual thing. And I was like, it sounds irresponsible. Just make sure that you cross all your T's and you like went back and they had the study, they had the clinical study. I remember, I was like, Oh, that's pretty impressive. Like normally you don't have that kind of thing at that stage. Right. So the


Jordan Crook  38:43  

interesting thing I think about CBT is yeah, like you need a practitioner, right? You like you need someone to kind of like run the system because it is so formulaic. But a bunch of it is homework. So if you think about it, it actually is like perfect for a virtual application. And I just think that, you know, they really tapped into something and it wasn't the only smoking cessation thing that I was pitched that had to do with CBT. But it was clearly the one that where they had the right path and strategy even with the direct to consumer thing kind of messed up. I think the idea to do all that early research was so important and the path less traveled by right like the more difficult journey but they that was the right call ultimately,


Darrell Etherington  39:23  

yeah, great conversation. A lot of questions remain for like, what happens next in regulation, but in another episode where we talked about US healthcare, and I get so angry inside just seething with rage, but you know, that's my lot in life.


Jordan Crook  39:37  

No, Canada. Did you did mention Canada?


Darrell Etherington  39:39  

Of course I do, of course. Anyway, please go and leave feedback for us. On our iTunes thing in the reviews when you give us five stars leave us a good review. We'll read that. And then also you can give us direct feedback on our listener survey. That's right a listener survey because we care about you. We want to Hear about you want to hear about what you think of the show what you want to hear more of in the show? And you can fill that out. It's only a couple minutes of your time at Bitly. That's listener survey. Give us your thoughts. Again, five star reviews also great. We'll be back. We'll see you again. Founders hosted by myself, TechCrunch news editor Darrell Etherington and TechCrunch Managing Editor Jordan crook. We are produced by shad Kulkarni and edited by Grace Mendenhall and Maggie Stamets is our associate producer TechCrunch. His audio products are managed by Henry pic of it. Our guest this week was use of Sherwani co founder and CEO at Quiddity. Yes, you can find us on Apple podcast Spotify or wherever you get your podcast and on slash fan. You can also email us at You can call us and leave us a voicemail at 510-936-1618. Also, we'd love if you could spare a few minutes to fill out our listener survey at bit fly slash bound listener survey. Thanks for listening and we'll be back next week.


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