You might have first heard of Ro as Roman, the digital health clinic for men, treating issues like erectile dysfunction and hair loss. But over just a few years, cofounders Zach Reitano, Rob Schutz, and Saman Rahmanian have expanded the business—they’re now building a patient-centric healthcare system. Ro’s vertically-integrated primary care platform powers a personalized, end-to-end healthcare experience from diagnosis to delivery of medication to ongoing care. In just the past year, Ro has expanded to offer specialized support for weight management (Plenity), fertility (Modern Fertility), mental health (Ro Mind), in-home care (Workpath), and at-home diagnostics (Kit). As of its $500 million Series D in March, the company is valued at $5 billion.
Primary’s Jason Shuman sat down with to talk about the perspectives that have allowed him to build this consumer health empire, from how he tackles problems to why patients always need to be the priority and things he’s learned over the course of fundraising.
See a deeper dive on our new digital publication, First Edition.
What’s your telehealth origin story? What drew you to the space?
Every single person in my family has had a life-threatening illness at some point in time in my life—myself included. My dad has had four heart attacks and a stroke. My mom has a neurological disease. My sister, who is probably the biggest warrior of all of us, is a two-time cancer survivor and has an autoimmune disease and a brain tumor. I have a congenital heart condition and had a heart procedure when I was 18.
We were lucky. My dad is a physician and saved every single one of our lives. Whenever we had a question or concern, we would go to him and he would solve it from beginning to end. Our closet at home looked far more like a pharmacy than it did like a closet. And when he couldn’t solve it, he would find the person who could and he would shepherd us through the healthcare system.
I’m sure a therapist would have a lot to say about this, but I think I’m trying to recreate my dad with software, to keep him around, and to make sure everyone gets to have someone caring about their health like he did our family’s. Everyone deserves access to high-quality, affordable healthcare.
What was the moment you knew you had product market fit? What kinds of questions do you suggest consumer healthcare founders ask themselves to get to that moment?
We knew day 1. We knew how lucky we were, because my cofounders and I have built startups before, and we didn’t always get to product market fit right away.
Any founder, not just consumer founders, should have one goal in mind (and this is from my YC days): Build something people want. To do so, write code (or build) and talk to users. Nothing else matters if you don’t build something people want—not unit economics, not whether something will break at scale, nothing.
People often have trouble with this. They convince themselves people want what they built because it’s difficult to acknowledge when something you poured your heart and soul into isn’t wanted. However, numbers don’t lie. People either are willing to pay for your product (or consistently use your product) or they aren’t.
How you find product market fit is an art and a science. But, if you ever have to ask yourself if you have it, you don’t. When there is doubt, there is no doubt. When you find it, you’ll know.
How did you acquire your first customers?
For us, it was pretty classic consumer—word of mouth, Facebook, Google etc.
When you think about scaling, how do you think through what rate to grow at, what functional areas to scale in, and in what sequence?
There are no magical answers or numbers here. It’s different for each business and each market. The two things I would emphasize here are for founders to do two things: play the game on the field and solve the problems with the shortest fuse first.
In terms of playing the game on the field, Bill Gurley has a great quote here and I won’t try to say it better than he—“I think everybody, to a certain extent, has to play the game on the field. I like to use the example of Hortonworks and Cloudera. So we're in this company Hortonworks, it's a Hadoop company. Cloudera raises $950 million from Intel. What do you do? You could sit around and say, "We're going to get to profitability," but you're not going to matter. You might as well lock the door and leave the building.”
In terms of solving problems with the shortest fuse, the best startups do not solve all the problems at once. They solve the ones they need to in order to consistently de-risk the business and let all other fires burn. It’s difficult to let a fire burn, let alone grow, but it’s absolutely essential because it’s impossible to solve all problems simultaneously.
What advice do you have for other telehealth founders?
Understand the flow of money. Only by doing so can you understand the incentives that drive the behavior of every stakeholder. That is one of the primary reasons that Ro’s services are cash pay. Our cash-pay model means we are responsive to the needs of our patients and that patients can hold us accountable. We either make their life better or we go out of business.
Too many healthcare organizations are not incentivized to respond to the needs of patients because the patient is not their customer. My advice is to make sure you don’t lose sight of the interests of the most important stakeholder, the reason we all do this in the first place: the patient.
What’s something you’ve learned over the course of your pitching process?
I could go all day here but I’ll share a few tidbits:
- Always be authentic and operate with integrity.
- Not all investors are created equal.
- Have instant recall for all of your core metrics.
- It’s not an investor’s fault if they “don’t get it.” It’s yours.
- Look for a well-rounded cap table, not a well-rounded investor. (You’re building the Avengers, not a team of pretty-good-in-many-areas).
- Cost of capital can be a structural advantage if you know you’ll need a lot of it. Treat fundraising and investor relationships accordingly.
- Ensure mission and time horizon alignment .
- Raise more than you think you’ll need.
- Acknowledge and attack your businesses weaknesses head on, don’t pretend they don’t exist.