Zachariah Reitano first experienced erectile dysfunction (ED) at age 18. He told his father, a physician specializing in sexual health and sexually transmitted diseases, who then scheduled a cardiologist appointment for his son. He had a stress test and ran on a steepening treadmill, which made his heart beat faster, and then he collapsed in the doctor’s office. Reitano had a procedure a few days later that fixed his heart. Unfortunately, he continued to experience ED as a side effect of the heart medication he was prescribed.
While at the venture studio Prehype a few years later, Reitano experienced heart symptoms again. After undergoing various tests and being prescribed that same medication, his first concern was about intimacy. He talked about his experience with Saman Rahmanian and Rob Schutz in 2017, and they were inspired to make high-quality healthcare accessible and convenient. They initially launched Roman, a digital health clinic for men, but quickly scaled and expanded. Two years later, Ro is on its way to being a digital hospital with three digital health clinics: Roman, Rory and Zero.
On Monday, October 28, 2019, Bloomberg Television’s Scarlet Fu discussed telemedicine, operating a startup in a highly regulated industry, and the virtual doctor’s visit with Reitano, CEO and co-founder of Ro, as part of the Cornell Tech @ Bloomberg Speaker Series at Bloomberg’s Global Headquarters in New York City. Their conversation followed opening remarks by Greg Morrisett, the new Dean and Vice Provost of Cornell Tech.
Choosing a Market and Business Model
Ro is a direct-to-consumer telemedicine service with three verticals: Roman currently treats men for sexual health, hair loss and daily health concerns; Rory currently treats women for sexual health and menopausal symptoms; and Zero focuses on smoking cessation. Patients consult doctors online and receive personalized treatment plans that include prescriptions from Ro’s online pharmacy for a low friction end-to-end care experience.
Patients pay doctors directly for the consultation, and doctors pay to use Ro’s digital doctor’s office software. Ro’s revenue also comes from its online pharmacy that takes advantage of low-cost generic drugs. To date, Ro has raised over $100 million and is “default alive,” meaning that Ro can achieve profitability if it continues to grow and maintains growth rates and margins.
Identifying the Market Need
There’s a prescient market opportunity for Ro. The U.S. is predicted to experience a shortage of 100,000 primary care providers by 2032. “The only way we as a society have ever been able to do more with less is through technology,” said Reitano. “We at Ro see this concept of providing – or giving providers superpowers – as a way to scale high-quality care.”
In nearly two years, Ro has facilitated 3 million patient/physician interactions and treats over 10 conditions. The company uses technology to leverage the workforce and create more affordable treatment options in an environment where ever-increasing health insurance deductibles force patients to shop around.
Uncovering the Diagnosis
Patients can click on a treatment on Ro’s websites to go through a dynamic online visit. They answer questions about their symptoms, health background, lifestyle, and family history, as well as upload any diagnostic images. In the past, the collection of physical samples directly from a patient has hampered telemedicine. Now at-home testing and health devices create tremendous potential for Ro to treat more conditions on its platform.
“We also pull in third-party data about that patient, and that information is analyzed, synthesized and presented to that physician,” said Reitano. “The average doctor’s visit is about 12 minutes, and patients spend about 15 to 20 minutes on the Ro platform answering those questions. What it allows the physician to do is dive in very quickly to the nuance of that patient and talk to the patient specifically about what makes them unique.”
Doctors interact with patients via messaging, phone, or video chat. If the physician thinks the patient’s symptoms indicate an underlying condition, they’ll recommend the best next steps – like quitting smoking or additional testing – and educate and help patients through those next steps.
“We start by treating that condition, but it actually allows us to start that dialog. And anytime you reduce friction to talking to a physician, if the patient has that opportunity, they’ll continue the dialogue about other conditions,” said Reitano. “We call it patient-led health care.”
Patients ultimately determine whether they want to accept the physician-recommended treatments. Only 14% of patients end up with a prescription, but the Ro prescription is the start of an on-going dialogue between the patients and the physicians.
Operating a Business in a Highly Regulated Industry
Medicine is regulated on a state level, which creates a regulatory spider web. Each state and the District of Columbia have their own medical and pharmacy boards. The U.S. Food and Drug Administration (FDA) regulates medication and treatments, and the Federal Trade Commission (FTC) regulates advertisements. At minimum, Ro must comply with 104 regulatory bodies.
“We have to both make sure that we respond to the idiosyncrasies of each state, both on the doctor’s office side and the pharmacy side, as well as broadly more nationally. And that has implications specifically for how you establish a patient/physician relationship,” said Reitano. “One of the reasons why we think Ro has been fortunate in terms of the timing of the business is because of the mass of evolution in telemedicine regulation.”
Since 2015, every state permits online patient/physician relationships, but states use their own language and have different requirements for those relationships. Ro’s engineering, medical, and legal teams work together to ensure compliance.
“Our platform is built on a per condition, per state basis. So you can imagine the permutations we have to account for depending on what diagnostic data is required to satisfy the standard of care according to our medical advisory board and physicians on the platform,” said Reitano.
Physicians on the platform go through a rigorous 12-step process for medical malpractice standards, background checks, and individual practice cases. Ro also ensures that its physicians stay current about the latest research, and its medical advisory board educates and trains the network of physicians.
You can watch the entire discussion below: