When Stephanie Tilenius, a former senior executive at eBay and Google, decided to start a health-coaching app, many in her network were incredulous. “Everyone thought I was crazy,” she recalls. “Some people loved that I wanted to do something to help others, but a lot socially ostracized me.”

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For many entrepreneurs, the health sector offers an enticing opportunity–with strings attached. It’s an estimated $3 trillion market and is still dominated by a cadre of traditional players. But many in the technology sector have shied away from the industry after witnessing many high-profile failures and realizing that change doesn’t happen quickly. “Silicon Valley operators and investors see that health care needs better technology,” explains veteran health IT consultant Ben Rooks. “But they learn quickly that health care isn’t about radical disruption; it’s about slow evolution.” “Silicon Valley sees that health care needs better technology, but they learn quickly that health care isn’t about radical disruption; it’s about slow evolution.” Despite the challenges, a small but growing group of former technologists from companies like Google and Twitter are in it for the long haul. In many cases, their motivations are deeply personal: A family member lost to chronic disease, or a brush with the broken health care system. I spoke to four former tech executives about their reasons for moving into health care, the cultural differences between the two sectors, and the challenges they’ve faced along the way. “Because patients deserve better than a seven-minute visit.”–Stephanie Tilenius, former VP of commerce and payments at Google and former GM and VP at eBay and PayPal Stephanie Tilenius started her career at e-commerce companies like eBay and PayPal, and eventually ascended the ranks to become a senior vice president at Google. But prior to joining eBay in 2001, she spent a few years at an online drugstore called PlanetRx. That early experience in health care had a lasting impact on Tilenius. When her father got sick, she felt an even stronger pull to quit her steady tech job to make an impact in the sector. “My father had multiple chronic conditions and went from doctor to doctor,” she recalls. Stephanie Tilenius [Photo: courtesy of Vida] These days, she is the CEO of a startup called Vida, which provides virtual care for patients with chronic ailments. Before starting the company, Tilenius reflected on her father’s need for “continuous care,” which would involve all of his care providers communicating with him and each other between office visits. Tilenius believes his heart attack could have been avoided, or at least delayed, if he had received better care than a “seven-minute visit, in which all his doctors would all just tell him to change his diet.” Unlike many of her peers in health tech, she made a point of working closely with medical centers that were already developing clinically validated programs for treating patients with chronic disease like diabetes, depression, and hypertension. She started Vida to make these programs more accessible by shifting some of the components online, and connecting patients with virtual health coaches to inspire long-term behavioral changes.

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At first, many friends and acquaintances in her network couldn’t understand why she’d leave a successful career in tech to start a health company that would likely grow and monetize at a slow pace. “People didn’t understand why I would leave a senior role and money on the table,” she says. “In Silicon Valley, it’s about hypergrowth, and if you’re not doing that, then there’s something wrong.” Likewise, many in health care were skeptical about technologists moving into their own complex sector. Tilenius believes that she’ll ultimately show her detractors on both sides that new platforms will emerge in health care, starting with mobile and cloud, and that companies like Vida will be at the forefront. Ultimately, she asks, “Don’t you want us crazy Googlers to help people by building companies and taking risks?” “It’s a quest for purpose.”–Katie Jacobs Stanton, former VP of global media for Twitter, and Othman Laraki, former VP of product management at Twitter and former product manager at Google For Othman Laraki, the CEO of Color Genomics, the migration of technologists to health care is inevitable as the so-called “internet generation” ages and their priorities change. Laraki’s company offers a $249 test to screen people for gene mutations associated with various cancers. Laraki says he left a job in product management, in part because he learned that he is a carrier of one of these mutations. He also found through his research that those with an early awareness of their disease risks can take proactive and preventative steps. “Color started with a simple question,” he recalls. “Is this test something that could benefit my family as well as other families out there?” “In tech, [the adage] is kind of true that ‘if you build it, they will come.’ In health care, the quality of the product is like No. 10 on the list.” The shift to health care hasn’t been easy. One of the key differences between the two sectors, he explains, is the criteria for success. “In tech, [the adage] is kind of true that ‘if you build it, they will come’,” he says. “In health care, the quality of the product is like No. 10 on the list.” Other factors are more important, such as price, privacy, patient safety, relationships with key industry stakeholders, and so on. Laraki is confident, however, that this will slowly start to change with more data flowing in health care and the trend toward consumerization. Othman Laraki [Photo: courtesy of Color Genomics, Inc.] In the meantime, he says that Color Genomics has been able to get an edge on its rivals, in part due to the technology background of its founders. As an example, the company started out by pricing its product in a unique way. The founders made the test affordable enough for most patients to pay out of pocket. “It was unusual, but an effective way to reach a lot of people.” Most gene-testing companies will instead choose to work with insurance companies to maximize revenue, often at the expense of its patients. By iterating continually on the product, a talent acquired at Google, Laraki says the company was also able to cut the time it took to develop a fully compliant in-house lab from the expected one year to just three months. The response among those in the tech community to Color has been mixed. “I get a lot of, ‘That’s interesting,’ or, ‘Huh?’ says Laraki. But he and Chief Marketing Officer Katie Jacobs Stanton say that many of those same people want to get involved when they simply explain the opportunity. For Jacobs Stanton, the decision to join Color came after she watched her brother and father battle cancer. But she also had practical reasons for coming on board: “I follow the three-principal model,” she says. “Who are the people? What is the product? Could I help?” Jacobs Stanton, who is also an investor in Color, joined the company only after being convinced on all three fronts.

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“I wanted to build something of everlasting value.”–David Vivero, former vice president of rentals for Zillow David Vivero recalls a not-too-distant past prior to the Affordable Care Act in which a person with a chronic medical condition, himself included, could be denied health insurance. Things may have changed on that front, but many people still feel regularly dissatisfied with their experience in health care. That prompted Vivero to start a company geared to consumers and patients (most health companies are business-to-business). “I wouldn’t say it hit me like an epiphany,” he says. “I started with an image of a single page that could be a window into an important health decision, and then it evolved.” For Vivero, another motivator came after he became a parent: “Now, having a child, I wanted to build something of everlasting value.” “When you are out there speaking with the bluster of a typical Silicon Valley entrepreneur, try to modulate it. Start with empathy, and a desire to get it right for each individual user.” Vivero’s startup Amino aims to provide transparency for patients on physician quality and price so they can make more informed decisions. One of the challenges for Vivero has been to convince veteran health technologists that there’s a route to make money through consumers, he says. Aware that many companies have tried and failed to improve transparency, some industry experts are skeptical about his chances. “The first movers tend to have arrows in their backs,” he explains. But Vivero is convinced that technologists have a good shot at improving some aspect of the health experience if they stay humble and bring in experienced medical advisers. He says many entrepreneurs fall into the trap of eyeing the multitrillion-dollar opportunity and casting their net too wide without realizing that one sliver of the industry could be worth hundreds of millions. “When you are out there speaking with the bluster of a typical Silicon Valley entrepreneur, try to modulate it,” he advises would-be founders. “Start with empathy, and a desire to get it right for each individual user.”