The Game-Changing Women of Healthcare | Homeward: Cultivating Rural Health

"If you live in a county that's designated as 'rural,' your healthcare outcomes are far worse, to the tune of 23% higher mortality. In these rural markets, hospital closures...rural health clinic closures are increasing at an exceeding rate. There's half the number of primary care doctors and about an eighth or a tenth the number of specialty care doctors. And 10% of all rural counties have zero healthcare services whatsoever." -Dr. Jennifer Schneider

Meg welcomes Dr. Jennifer Schneider, Co-Founder and CEO of Homeward Health, a technology-enabled, community-based healthcare provider delivering high-quality care to those who lack access, specifically rural Americans and the Medicare population.

Discussion topics:

Leveraging technology and AI to make healthcare delivery more equitable
Dr. Schneider’s personal experiences receiving care in rural US
The differences in cultures of care
How a care model focused on partnership, rather than competition, can help fill service gaps
Female leadership
Gender gaps in ownership, payment equity, and value perception
Homegrown, an initiative from Homeward working to mitigate these issues through mutual learning and support

Further Reading:

Episode Credits:

The Game-Changing Women of Healthcare is a production of The Krinsky Company.

Hosted by Meg Escobosa.

Produced by Meg Escobosa, Calvin Marty, Chelsea Ho, Medina Sabic, and Wendy Nielsen.

Edited, engineered, and mixed by Calvin Marty.

All music composed and performed by Calvin Marty.

Creators & Guests

Host

Meg Escobosa

Meg Escobosa has 15 years of innovation consulting experience, focusing on the unique challenges of healthcare since 2012. For The Krinsky Company, Meg leads client engagements overseeing advisory board design, creation and management. She also leads industry research, expert recruitment and trend analysis to support corporate innovation initiatives centered on the future of healthcare. Her background in innovation and strategy consulting began at IdeaScope Associates where she was involved all aspects of strategic innovation initiatives including understanding the voice of the customer, industry research and aligning the executive team to invest in promising strategic growth opportunities. Meg received her BA in Latin American Studies from Trinity College in Hartford and her MBA in sustainable management from the pioneering Master’s degree program, Presidio Graduate School. She is also on the board of a non-profit foundation focused on researching and developing technology to support a sustainable society. She lives in San Francisco with her husband and two teenage daughters.

Producer

Calvin Marty

A man of many hats, Calvin Marty is a Podcast Producer, Editor, Engineer, Voice Actor, Actor, Composer, Singer/Songwriter, Musician, and Tennis Enthusiast. Calvin produces, engineers, edits, mixes, and scores The Game-Changing Women of Healthcare. Calvin is also the creator of the 2020 podcast, irRegular People, among others. Find his music under the names Calvin Marty, Billy Dubbs, Nature Show, and The Sunken Ship. Over his long career as an actor, Calvin's has voiced many Radio and TV commercials for a wide-range of companies and products and has appeared in small on-camera roles on shows such as Chicago Fire and Empire.

What is The Game-Changing Women of Healthcare?

The Game-Changing Women of Healthcare is a podcast featuring exceptional women making an impact in healthcare today. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers. We dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. Join host Meg Escobosa in conversation with some of the many brilliant, courageous women on the front lines of the future of health.

Jennifer Schneider: If you live in a county that's designated as 'rural,' your healthcare outcomes are far worse, to the tune of 23% higher mortality. In these rural markets, hospital closures, rural health clinic closures are increasing at an exceeding rate. There's half the number of primary care doctors and about an eighth or a tenth the number of specialty care doctors. And 10% of all rural counties have zero healthcare services whatsoever.

Meg: Welcome to the Game-Changing Women of Healthcare, featuring exceptional women making an impact in healthcare today. Together, we dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers.

I'm Meg Escobosa. Join me in conversation with some of the many brilliant and courageous women on the front lines of the future of health.

Welcome back to the Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. A quick note before we get into today's episode. We are currently looking for sponsors for the podcast. If supporting and encouraging female leadership in healthcare is important to you or your organization, help us do that by becoming a sponsor of the Game-Changing Women of Healthcare.

Reach our engaged audience. with a mention by me, in future episodes or we'll produce a short audio spot for your organization. At The Krinsky Company, we believe in female and diverse leadership in healthcare. If that's important to you too, become a sponsor of the podcast and proudly share your values with the world.

Reach out to us at podcast@thekrinskyco.com, and thank you.

Today on the show, we're joined by Dr. Jennifer Schneider. Dr. Schneider is the Co-founder and Chief Executive Officer of Homeward, a company focused on re-architecting the delivery of health and care in partnership with communities everywhere, starting in rural America

Having grown up in a small town and being diagnosed with type one diabetes at a young age, she experienced, firsthand, the challenges of accessing convenient care that millions of families across rural America deal with every day. This fueled her passion to found Homeward and create novel value-based care models that are purpose-built to address the needs of rural Americans.

Previously, Dr. Schneider served as Chief Medical Officer and President of Livongo. While there, she led the company through the largest consumer digital health initial public offering in history and the industry's largest merger, ever, between Livongo and Teladoc Health. She also served as Chief Medical Officer of Cast Light Health.

She completed her bachelor's degree in biology at the College of the Holy Cross. She went on to get her MD at the Johns Hopkins University School of Medicine and her master's degree in health services research at Stanford University. Jenny, welcome to the show. We're so happy to have you here.

Jenny: Thank you so much. Excited to get to be here.

Meg: So Jenny, Homeward Health, you're tackling rural health care. Tell us about this problem. What is the biggest challenge with getting care to rural areas today?

Jenny: Yeah, sure. Thanks, Meg, for the question. Just to take a step back, when we did the transaction of Livongo, I had a chance to take a moment, reflect, and think about what it was that I wanted to concentrate and spend my time on next.

And as part of that journey, I spent some time with my co-founder, Amar Kendale, and we decided that whatever it was we wanted to do, it had to be really big and it had to move the arc of healthcare in the right direction. And so we spent time thinking through different theses and different ideas. And where we landed was we found something that was really big and broken that we thought we could be helpful in uniquely fixing.

And that was healthcare delivery in rural healthcare markets. So if you take a look at outcomes for people who live in a zip code where the last three digits designate you as rural, and for those of you who don't know, there's a RUC listing and there's nine different zip codes - coding classifications.

The bottom three are rural. If you live in a county that's designated as rural, your health care outcomes are far worse, to the tune of 23% higher mortality.

Meg: Wow.

Jenny: We also know that in these rural markets, hospital closures, rural health clinic closures are increasing at an exceeding rate. There's half the number of primary care doctors and about an eighth or a tenth, the number of specialty care doctors and 10% of all rural counties have zero healthcare services whatsoever.

So Amar and I said, “Okay, do we have experience here that may be useful to help build?” And the two key core tenants that we came up with were number one, you had to build healthcare services on a technology stack such that you could scale. In an area where there were not services, you couldn't, you know, artificially imagine you could bring more services into the market.

So we had a lot of experience doing that at our various companies in the past. And the second was we really had to align economic incentives for healthcare delivery. Meaning, we really wanted to give people the right and the opportunity to get paid for doing the right thing to keep people healthy in the system.

Another buzzword for that is “value based care”, but owning the responsibility, financial responsibilities, and therefore acting appropriately on what types of care could be delivered. So those are the two key core tenets, and so we launched Homeward about a year and a half ago.

Meg: Super exciting value based care itself, just defining that as, you know, you're paying for prevention versus treatment, right?

Jenny: You're really trying to keep people healthy and you do end up paying for both. Let's be clear, but there is definitely a larger emphasis on what can I invest in to keep people healthier? And sometimes that's healthcare, flu shots, COVID shots, you know, blood pressure screening. Sometimes, it's food adequacy or ensuring that there's safe transportation to actually get to a specialist so that that appointment actually does happen and isn't avoided.

And then you live with the long-term consequences, which are often worse for health and worse for the economic system within healthcare.

Meg: And in rural areas, there are so many challenges, but you know, technology, do you find that relying on technology in this area is a challenge for patients?

Jenny: It's an interesting question. I think that technology, in general, has a real opportunity to advance us in health care delivery, particularly as it can take out a lot of the inefficiencies. So there's a lot of technology assets that can be used that nobody even feels that they're being used. It's just that the process is better, it's faster, it's cleaner, it's more accurate.

So there's no hesitation on a member usage for those applications of technology. In addition, I do think there are things that we ask or encourage our members to do vis a vis technology, such as remote patient monitoring, such as telehealth. Rural is different than urban in that there's a higher level of trust, meaning you have to overcome a higher barrier to earn your right to be able to deliver services.

So it's this combination that we've learned around being in person and delivering technology services. It's not simply mailing technology to somebody's house and asking them to use it. It's spending the time to get to know the person to set it up so that they trust the system. And then they'll start to use it and continue using it.

Meg: Right. The why.

Jenny: That's right.

Meg: So how exactly is Homeward Health delivering care and where exactly do you come into the picture?

Jenny: So Homeward comes in the way that the model works, I'll talk about our business model and then our care delivery model. So the business model is we partner with insurance companies, so payors, and we partner with them to take on full responsibility of the lives that they have in a rural county. So for example, a member may have Medicare Advantage members, dual eligible Medicaid-Medicare, Medicaid. And we come in and say, “Great, we're going to be financially responsible for those people and ensure that they have improved clinical outcomes.”

So the first thing we do is we leverage our technology and our data to help inform those existing primary care doctors how they can perform better. So we partner with existing primary care doctors, not in a competition, but as an added benefit and added bonus to their care delivery practice. And then when we identify gaps in care for services that have not been done, cannot be done, may not exist in that certain county, we come in and fill those service gaps with our own clinical team.

The combination of the two is really important because we know that there are great doctors in rural America. It's not a commentary on the doctors, but they're often overworked and they don't have the time to actually do all the things that need to get done.

In some counties, there's simply not enough care clinicians to actually provide the care that's needed, right? So it's that combination of leveraging our services for the primary care doctors and existing health systems within that county, allowing them to practice better, deliver better outcomes, participate in a value-based care arrangement with the payer, and then filling those gaps and holes where they exist.

Meg: So you mentioned you know that Homeward is not in competition with the providers. What's the response been from providers to your services?

Jenny: Yeah, out the gate, we knew that I come from rural America, so I know this. So if there's not enough healthcare services operating at high quality in the market, coming in in a competitive force doesn't help anybody. It does not help us accomplish our mission.

So we took actually a very different approach and we looked across the ecosystem and said, “Who is there that we can partner with? One, make them better. And two, make us better - better on behalf of the community of the members that we're servicing,” and so we're not in a competitive moat or mode at all.

In fact, our services that we supply to the existing health systems and providers are very much welcomed because there are things that they don't have, data that they can't receive extra hours, extra hands that they don't have to be able to deliver the care that they want to deliver for the population.

Again, this is a win-win because what we're doing is making communities healthier, allowing providers and health systems to operate more efficiently and aligning those economic payment terms such that the payors are giving, you know, the rates to the doctors when they're doing the right thing for the population.

And we kind of help providers make that transition into value-based care by backstopping the financial risk in this process.

Meg: The data piece - so today data lives in many different places. Do you rely on the payers for understanding the status of the patient or is that coming from the provider? Are you doing a mashup, if you will?

Jenny: Yeah, I would say. Right, I would say, I would say, “Yes, and,” is how I would answer that. So we integrate for sure from electronic health records where doctors are inputting their information. We absolutely receive claims from the payer, the insurance arm to understand what they're catching and collecting overall.

We have our own streams of data that include things like real-time remote patient monitoring. So this is, you know, very much a, can we collect the data and then can we identify the population that has the highest need and go intervene in that population. We ingest, we normalize, and we leverage that data to help guide decisions for existing health systems and providers in the county and for us as we supplement that.

Meg: And when did you go live with your services?

Jenny: We went live late last summer, a year again, about a year, and then live in Minnesota earlier this spring.

Meg: Congratulations.

Jenny: Thank you.

Meg: How has it been going and how much more complex is it now that it's up and running versus what you envisioned? I mean, it's always when you get into something big, knowing what it really is when you're starting, you might not start. I'm curious if you've had any of that experience.

Jenny: Well, having gone down this journey two other times, I think the simplest idea in healthcare becomes highly complex because it's a regulated industry. And so under every corner and turn, there's lots of surprises, even as you're starting out. Even as you're finishing, there's still lots more surprises.

So, the answer is we are so proud because the people that we've been able to serve and service love what we're bringing to them. It's very clear that we're hitting a need within the market and really delighting the end members to whom we're providing care so that is our North Star. That is why we're on this journey, and sure, every state, every county has its own unique complexities, but we've figured out a number of patterns that have allowed us to be able to actually start to scale this more nationwide.

Meg: So we've talked a little bit about the back end, can you describe sort of what the patient experience is?

Jenny: Sure. About 70% of patients today have or identify that they have a primary care doctor. That means they have somebody that they see. So imagine, Meg, you go in to see your primary care doctor and we've been kind of working in the background and we noticed that your blood pressure is up a little bit, you know, like in intermittently and your primary care doctor kind of notes it on the chart, but isn't super concerned.

We may say, “Hey, look, we're going with your primary care doctor, we're going to deliver a remote patient monitoring tool to you to follow and track your blood pressure such that we can see what's happening when you're outside the doctor's office.”

You only go to the doctor's office two times a year.You're in there for 10 or 15 minutes each time. So we can start to understand and track. So that saves you a trip to the doctor's office. It saves the doctor themself a whole slot that needs to be filled with somebody who's maybe more critically ill, And so what you see is like more attention, more care and a decision making plan that helps augment what you need in that time.

Meg: And it’s no extra cost to the patient.

Jenny: No extra cost to you, right? Because what we're doing is we're actually, you know, sitting on top of that and making sure that you're receiving the services that you need and that's a service that you would need. Yes, that's right.

Meg: I'm curious if your service addresses things like the food desert in rural areas. What if the observation is that somebody just needs a better diet? Is that something that your service can address?

Jenny: Yeah, and that's an observation in lots of people who live both in health deserts and in rural markets. So that's not an uncommon observation. There are a lot of, you know, other links within the community that somebody may not know about.

There may be food services, soup kitchens, or maybe fresh fruit deliveries that they just haven't tapped into. So the first thing we do is actually understand deeply within that community, what's available, what's included in the insurance plan that these people who are in Medicare Advantage have actually enrolled in and help them navigate those benefits.

Like that's a big step and you can get, you can get pretty far in that. I mean, we forget as care providers the system is very complex for people trying to navigate it. And, oftentimes, someone needs an advocate and a navigator to help them figure out and connect the dots as to what those benefits are and just make them real and make them happen.

Meg: Let's talk about this leadership role you're playing, like launching businesses, leading them to M&A outcomes, you know, mergers with your Livongo experience. Can you tell us about what it was like to be a part of Livongo, merge it with Teladoc and what that experience was like?

Jenny: Yeah. So I think that the, you know, the key to any great business, not a good business, but a great business is to keep your eye on the mission.

And I say that in Livongo, we were incredibly mission-focused and, there, our mission was to empower people with chronic conditions to live better lives. That's it. Like it wasn't, it wasn't to take the company public, which we did. It wasn't to sell the company, which we did. It wasn't to raise more money along the way, which we did.

It was every day we talk about how can we empower, not help, how can we empower people with chronic conditions to live better lives? The reason I say that is that when you stay focused on that, you take advantage of these opportunities that help you get to scale differently. So many times young entrepreneurs will say, “Well, my exit plan is to be acquired or my exit plan is to take an IPO,” and like, none of those are exit plans, in my mind, those are just the, there may be offloading for financial outcomes. You may be able to take some money off the table, but the real exit doesn't exist if you're accomplishing your goal until you get to your goal, right? And if you do that, you will have many more opportunities to scale the business.

So I think, you know, an initial public offering, an IPO, is nothing more than a very big, massive branding event. It's a capital raise, and it's a signal to larger markets that you have the infrastructure to actually continue to scale to accomplish your goal. So it's a right, it's like the Bar Mitzvah, right, or it's the quinceanera of growing up as a business. But it's not, it's not the end destination. You don't think your life is done once you've worn your fancy dress and, you know, and celebrated with your family. Like that's just a rite of passage.

Similarly, you know, when we did the merger with Teladoc, the thesis was we needed to link closer to providers to get prescribing power and get closer to be able to provide that full suite of services.

Remember, we had a platform for chronic conditions, diabetes, hypertension, behavioral health, obesity. We had coaches, but we didn't have providers and prescribing power. I still to this day believe that the thesis of combining those two entities is incredibly powerful and was the right next step for the evolution for us to get continue on what our mission was, which was empowering people with chronic conditions to live better lives.

Meg: What was it, you know, what do you feel like your other insights and learnings are from that experience? And how is it informing what you're doing now?

Jenny: Yeah, I feel like I'm so fortunate because I've had incredible learning experiences often with other additional positive benefits, but I've done a bunch of really stupid things over the course of working and learn mostly from my mistakes.

The thing that I walked away most from Livongo was that leadership is about building teams and inspiring people to do their best work. And if you can do that, and you can do that in a way where people feel rewarded and they feel heard and they, you know, assume positive intent, you can accomplish anything.

And that as a leader, and this goes for teachers, it goes for coaches, it goes for parents; if you can state the slightly beyond possible, slightly beyond what everybody knows you can do, that's how you had the breakthrough. That's how you get to that next level. And so the idea around healthcare company creation is not to create something that's already in existence to add more noise into the ecosystem to break a barrier.

It's the Roger Bannister three-minute mile, right? It's like you're breaking a barrier. And so your job is to motivate, inspire people to work toward doing that, celebrate the wins, celebrate the failures and allow an environment where people feel they can leave the fear behind them and actually try to go for it.

And that's, I learned that lesson in spades at Livongo and the culture that comes with that and the enjoyment of work and the amount of laughs that we had together as a team as we were creating something was, was a really incredible journey and experience for me.

Meg: I absolutely agree with you and have experienced that myself. When people push you to see beyond what you think you can do, it's just, it's powerful.

Can you talk about one of those failures? I want to hear a story about something that you, it doesn't have to come from Livongo, could be anywhere, but it’d just be interesting to hear, like, you know what, this is what happened, this is what we learned from it.

Jenny: Well, I can talk about a very clear Livongo one. So it was going on between 2016 to 2017 and we had decided, as a leadership team that we wanted to become a platform, which a lot of people use that word now, but we wanted to become more than a point solution.

So we launched in diabetes and we decided to launch in hypertension and I made a decision to launch in hypertension with people with diabetes. So we weren't going to build two point solutions on a platform. We were going to build in two point solutions that intertwined to address like a complex, it's much more complicated build. And the build seemed to go great, the team was great. I brought in an incredible, very smart cardiologist. Bimal Shah became our Chief
Medical Officer. He was great. And then I got to launch the go-to-market strategy for that with our sales team, and I did that over the holiday break. We had our go to market kickoff in January - I think it was in Texas.

And I have, I stood up and launched it and it felt like I've not had like such a negative response because the sales team's response was, “You've just complicated my job. I'm selling in diabetes and it's selling great.” Like, well, that's great for you. It's just not great for the market, like for the business, like the business has to evolve, people's experience has to evolve. But what I learned in that process is I had done all the work in the building. I had not done enough socializing work to get the buy-in at the go-to-market sales motion. So it was a unified flop, in terms of announcing it to the sales team. It was still the strategy we stuck to.

It ended up becoming a winning strategy, but took a lot more revs to go back, you know, with my head between my, you know, like head bowed and tried to like explain the why. And so there's a lot of, for me, there was a lot of learning there and what it takes to socialize and steer the course of a business.

Even a business that's moving really quickly and iterating very quickly, there's still a lot of time to get people's mind-shift to change.

Meg: Very good point. Was there a voice of market element to your work as well?

Jenny: There was for sure. We had a lot of client advocacy meetings. We had a client advisory board, and so they helped give us a lot of ideas, you know, oftentimes, they would tell us, like we'd bring in an idea and it would be completely shot down, which is humbling and very rewarding. And so this idea around being open and not wedded to your own ideas is really critical as you build, as you build businesses and build an experience.

And so I say this all the time, like the number one failure is like, “No, I know I'm right. I'm going to just keep going.” Like, you actually have to listen to the people that are trying to buy what you're trying to sell. And if you can't do that, no matter how great what you're building is, if you can't sell it, it's not a great business.

It's going nowhere. And I, you know, I recently had somebody come and say, “You know, that they had gotten feedback that they themselves appeared very young in presentation and that, you know, someone's like, well, that's okay. You're just young and smart.” I was like, “Actually, if that's the consistent feedback, bring somebody else who looks older.”

Like don't try to just like fix the problem. Like it's not, it's not on you. It's not a problem with you. But like, if that's the business problem, like fix the business problem, right? If that's the feedback you're getting, fix it rather than fight it. Those of us who try to fight the feedback we're getting from the clients that we're servicing don't do very well in terms of building businesses.

Meg: I hate to hear that, you know. They're too young looking.

Jenny: So do I.

Meg: And too old looking.

Jenny: For sure. And I get that. Right. And that's like, that's not a value that is consistent with your value or my value, but the conversation is different, which is like fix it as a business problem.

You can hold your values, but you have to fix the business problem as to like what's happening in that process and that cycle.

Meg: So Jenny, tell me about Homegrown. You've just launched this initiative surrounding female founders. That's so exciting. I'd love to hear more about it.

Jenny: Yeah, so I'm really delighted with the help of the Homeward team. We announced Homegrown, which is an initiative for me to get to formalize the sponsorship that I get to do across female founders and what that means is, you know, there's an application process we allow and expect and are really honored to have people apply to come in and I spend time on a quarterly basis with female founders talking about whatever it is that they need.

It may be fundraising. It may be leadership team and maybe cross between, you know, personal and work life, whatever needs they have. I just get to be a sounding board or a resource. And for me, selfishly, it means I get to have connection with these really incredible women who are coming up with great ideas and hopefully carve out a little bit of an easier path having bumped into some things myself, but it's a mutual learning. It's a real opportunity and something I am delighted to get to do and feel honored to be able to do.

Meg: I just admire it so much. I think that that's part of where we're coming from, too, with having this platform, the Game-Changing Women of Health Care podcast to engage with women, their experience and leadership, their learnings, their insights, and this mentorship piece is such a critical one.

I mean, the number of times I've even heard and felt personally, the concept of imposter syndrome, you know, and just the stats about women not going for things when they see a job opportunity. I [don't know if you've noticed that yourself in your observations, connecting with women, pursuing leadership.

Jenny: I think it's a common trait where women want to be trained and confident that they have what people are looking for. I think once you've been in a leadership role, you realize that half the time you're making it up as you go along anyway. And so the training was nice, but maybe all that relevant.

I have two girls and a boy. All of my children, I think we live in a very empowerment household and you know, like we don't say, “You can't,” we say, “I'm not allowed to, like right now you're not allowed to jump off the roof and try to fly. Not that you can't, you're just not allowed to do that right now.”

My daughter, when she was - my middle daughter, when she was in the second grade, I got to go to her classroom and it was like a parent-teacher, they showed you the work they'd been going on and she immediately walked up to like a 6th grade work thing and sat down like long division. She was in the 2nd grade.

So I was like, “I'm pretty sure she doesn't know how to do this,” and the teacher comes over and she's like, “She doesn't really know how to do this.” I was like, “I know, but she believes that she knows how to do this and she has the confidence.” And so I sat there and watched her like, you know, and again, well, she didn't really know what she was doing, but I was so proud that she didn't have that. So the reason I say that, I don't think we're born that way. I don't think it's like we're born with that. There's something about society that influences that. Like, why can't we all just act like we can do more things because half the time you actually can do it, you know, half the time you still can't, but half the time you can. And so why not take that chance?

Meg: Yeah, it's fabulous. If somebody's out here listening and they themselves are founder, they want to get involved, how do they get involved in Homegrown?

Jenny: Oh, great question. There's a website on our Homeward Health website. So just come take a peek. There's an application link for an application. So I’d be delighted to review and get to meet or just reach out. We've got lots of people. I reach out directly to me or to someone on the Homeward team, but we'd love it - to have a chance to meet and hear if I can be of use in any way.

Meg: Did you have mentors that you benefited from?

Jenny: I did. And this idea around paying it forward is an incredibly important one. And I had good fortune of having both female and male mentors. So I had Dena Bravata, who is the first chief medical officer at Castlight. She's an incredible mentor and friend.

I had Sandy Fenwick when I was at Livongo, who is the CEO of Boston Children's Hospital.

I had John Driscoll, who is the president at Castlight for a while, who has continued to lean in and sort of pay it forward with mentality. And again, there's an intellectual help and there's a relationship that you get when you have multiple genders, multiple generations over time.

And I like to say like, there's no need, no reason why everybody needs to have the same set of scars on their back. Like get new scars. Like there's going to be other hard problems that you're going to have to uniquely face, but like leverage those people around you who've done it before and can maybe help shortcut.

You know, there's no pride for copying homework in the early stages of the things that can, you know, can help get you further faster. And so I think it's a humility to ask and a delight for people who've done it before to get to share.

Meg: What do you think some of the biggest challenges are for women in leadership? Have you been seeing based on your own experience and then the women you're mentoring a common theme or thread across them?

Jenny: Well, I think that, you know, if you look across payment, like women in C-suite titles still get paid less than men in C-suite titles. So there's definitely a payment equity component.

So that to me is a perception of that, how are women perceived to be valuable? And I think the ownership on women to push harder to negotiate and demand higher salaries, I think it's a combination and one is easier to control than the other, but they both need to work in parallel. So I see that as a gap still.

I also think that women, until you hit a certain level, have a harder time of being authentic. And by that, I mean, you know, it's like, it's okay to be a mom and have kids and do those things, but it's not always okay to talk about it. Right. And you get to kind of like be this person who's, you know, like I lead all the time with, you know, like my car has got Cheerios in the back.

Like I'm a soccer mom. Like I got kids behind me and there's guinea pigs off and on the podcast and I'm with them like they're sitting behind my shoulders. And I do that not only to make people laugh, but to like with intent, like that is actually how I live. And there are other people, men and women, and it's okay that that's how you live.

You know, at the end of the day, you're held accountable for what you do. And so to be able to be okaywith being whatever that is, and allowing women to think that's okay, even if it's different, right?

Meg: I'd love to hear more about your background, your upbringing, like where you're from, how it all led you here to your work here with Homeward Health.

Jenny: Sure. So I grew up in Winona, Minnesota. I grew up with a very large family. My dad's the second oldest of 10. My mom's oldest of five. Everybody grows up and lives in Winona. I have 63 cousins on my dad's side alone. I am the third oldest grandchild and my grandmother passed away during COVID just a few years ago. Not from COVID, it was time for her to go. She had a beautiful, wonderful life and a very celebrated and loved passing.

Meg: Are you the first-born in your family?

Jenny: I'm the middle. Okay. I have an older brother and a younger brother. And I think of that as an advantage having an older brother.

I think first born children often get a lot of the parental pressure and middle children can kind of watch where they get into trouble and find other workaround methods to do the same thing and not get in trouble. So it's like you have a learning example in front of you. I got interested in healthcare when I was 12 and I was diagnosed with type 1 diabetes and that was my entrée into healthcare.

And I had an incredibly fortunate interaction with my own endocrinologist, Dr. Nelson, at the Mayo Clinic. And when I say fortunate, it's because I was 12 and he let this be my thing. He truly gave me the tools, the assets. I had very frank conversations around what was drinking going to do to my blood glucose.

You know, like when I had sex, what would that be like? And so the ideas are like, being a real person and understanding this condition setting. So I was a middle child. I'm competitive by nature, felt like something really hard to do that no one had done. So applied to medical school, ended up going to Johns Hopkins for medical school.

Thought I was going to be an endocrinologist because this was my idol and my doctor. And then I sat through medical school and I hated every minute of endocrinology because all I could think of was how they talked about the people with diabetes. They called them diabetics. They said they didn't, they were non-adherent, they were non-compliant.

And I sat there thinking, “This stuff is really flipping hard and this whole group of very smart people are judging the patient and the words that they use, that it's their fault, like that they didn't actually do the right thing.” If you had to count every time you opened your mouth and put a carbohydrate in and try to measure that and manage that with insulin and exercise, it's a really complex condition.

So I decided “no” on endocrinology. I decided yes, an internal medicine because it was complex because I trained at Hopkins and there was a line that all smart people go into internal medicines. I kind of bought into that as well. And then in the training, I loved the training. I loved the team aspect.

I love the intellectual rigor. I love the hard work of the training, medical school and residency. And then I got out in the real world and it felt like I was doing the sort of the same thing all the time when I was seeing patients and it felt interesting, but that almost anybody could do it.

And I take that with a little grain of salt, but it had to be any monkey could be trained to do what I was doing. You had to be a smart monkey, but any smart monkey could be trained. I want to do something bigger. And so I got back into looking at databases. I went back to graduate school and got a master's in health services research and said, “Can I do something at a population level that could actually really bend the curve of healthcare?”

And at that time I was looking around that industry in the ecosystem. And there's the likes of EVP and chief medical officer, Troy Brennan at CVS, who got cigarettes banned. Like he got cigarettes banned. And like, that's incredible to me, you know, and I'm like, “Whoa, like that, that's going to have more impact than me treating this person to bring their blood pressure down by a little bit.”

And so I got really excited and had the opportunity. I worked under a gentleman named Alan Garber. He's a health economist. He's now a provost at Harvard and he has this crazy friend, Giovanni Colella, who is a serial entrepreneur, who was starting a new company, trying to make, you know, trying to make a free market in healthcare.

And I was like, “That's great.” So I got really drawn into that journey and that ride, learned how to build products, learned how to impact things in different scales, you know, the idea of starting companies. I watched Giovanni assemble incredibly talented, smart people, bring them together on a mission.

And I was the speed, the evolution. I was hooked. Someone interviewed for the position I took at Livongo. The person I shared an office with when I was at Stanford doing my master's, Daniela Pearl Roth is her name. She's one of the smartest women I've ever met. And she said, “Hey Schneider, I think this is a job for you.”

And so I interviewed for the same job and I was like, “Yeah, this is great.” At that time, Livongo was interviewing for chief medical officer. And I thought what they were trying to do was leverage data for people living with chronic conditions to change behavior. So I fell in love with that and joined the company, transitioned into the role of president, oversaw a bunch of the company, helped build, grow, take it public, sell it.

And you know, like where I landed at the end of the day was, you know, where we, this conversation started, which is I wanted to do something big, hard at scale that could really change healthcare. And again, our approach in rural healthcare markets is taking a population that they're predominantly white and immigrant, disproportionately Medicare and Medicaid, and have very, very low access to high quality health care.

It's inequitable. We're solving an equity question. We're looking at equity from not from a gender or from a race, but from a geographic lens. How can we make healthcare delivery more equitable? Just in the time where, you know, if you look around the ecosystem and Livongo led some of this, but there's so many more great companies in the mix where technology, artificial intelligence had really, was really prevalent and established a path forward to do things differently.

And you, you cannot, you know, bring higher access, high quality healthcare services to hard-to-reach places without technology. And so like we thought the timing was right for the delivery of the services and an economic model that the world I think is generally moving toward, which is let's get paid for the outcomes.

Let's everybody who can get paid appropriately. There's enough money to make sure everybody's getting compensated for the work that they do. But let's allow them to do the work that we need them to do at a societal level versus individual payroll model. And so that was the evolution into Homeward.

Meg: Just as you recognize the need to have providers as part of the mix for Livongo to succeed and achieve your goals, you have the vision that you had. Have you recognized at this moment, you know, some missing pieces to the puzzle or that you, your dream that it's part of the plan down the road, what other elements of the ecosystem are kind of required to help you achieve what you're looking to achieve with Homeward Health?

Jenny: I think what we know is that it's an alignment and non-competition, meaning you have to leverage the ecosystem, the pieces and parts that are there in the real market.

We talked a little bit about that. Yeah. It's really critical. Understanding the great relationships you can have with pharmacists and the role that pharmacists play, community health workers, who are the influencers within a community, who are the social services that are available and adequate and ensuring that people are getting to what they need and what they deserve and helping navigate that is a really critical part.

This idea around creating something brand new to bring in and solve a problem is not the right approach. You know, I liken it to I've remodeled a house and I've built a house before. This is not a building of a house. This is a remodeling. And like which is hard.

People's brains are wired differently. I actually do better in a remodel than I do in a build. But in a remodel, it's like you get to turn around and evaluate and see all the valuable things that exist. You just maybe need to change the route to get from one room to the other room so that you can optimize it. And so there's a lot of value in approaching rural healthcare markets in that fashion.

Meg: Jenny, this has been such a great conversation. We're thrilled to meet you and hear about the work you're doing. I'm just inspired by your drive and your desire to give back and the contribution you've made really to impact healthcare at a large scale across the country and help people get the care they need and improve their well-being

Jenny: Thank you so much for the chance to connect. I really loved getting to be in conversation with you. So thank you.

Meg: Thanks for joining us for The Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho, Medina Shabich, Wendy Nielsen, and me, Meg Escobosa. This podcast is engineered, edited, mixed, and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts.

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