"A lesson that I think we all learned from the pandemic is the importance of community and authenticity."
Karl Ronn Tweet
First Mile Care’s founder and CEO Karl Ronn is a globally successful entrepreneur and advisor to top management at Fortune 500 companies. During his 30-year tenure in management at consumer powerhouse Procter & Gamble, Karl rose to the post of vice president of R&D and general manager of new business/healthcare; in that position, he oversaw global R&D for pharmaceuticals and over-the-counter health care and was responsible for developing P&G’s capability to deliver disruptive innovations.
Karl created entirely new brands that are globally revered, including Swiffer, Febreze, and Mr. Clean Magic Eraser. As a result of his strategic insights and understanding of consumer behavior, the new categories rapidly grew to $1 billion in annual sales. Karl has also founded multiple startups and consults with Fortune 500 companies wanting to create billion-dollar growth engines.
His book on turning disruption into business through partnerships, “The Reciprocity Advantage,” has received accolades from CEOs and academics alike. Karl also currently serves in an advisory capacity at Health2047, Inc.
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We are thrilled to have you join us today, welcome to ValiantCEO Magazine’s exclusive interview! Let’s start off with a little introduction. Tell our readers a bit about yourself and your company.
Karl Ronn: First Mile Care is a preventative chronic care company that develops affordable, scalable, and sustainable solutions to reverse health conditions like prediabetes. I started First Mile Care in 2018 with support from Health2047, the Silicon Valley innovation subsidiary of the American Medical Association (AMA). The First Mile Care program enables personalized support and guidance at the community level, giving people access to the coaching, tools, and resources they need to live better, healthier lives. The idea is that the journey of a thousand miles begins with one step and we’re that first mile.
In my previous career, I spent 30 years with Procter & Gamble, where I was vice president of R&D and general manager of new business in healthcare. Prior to working on healthcare businesses, I helped develop new billion-dollar markets with consumer products like Febreze, Swiffer, and Mr. Clean Magic Eraser. New markets require millions of people to change their habits. In consumer products we take it for granted that people will change their habits. Compare that with healthcare, where we believe people won’t change their habits. Leveraging those consumer insights on massive habit change is what brought me to healthcare.
Now, I’ve been able to apply my expertise in consumer marketing, demand generation, and behavioral change to establish best practices in diabetes prevention. (I also sit on the advisory board for the Johns Hopkins School of Public Health.) For example, I know that from a habit-change perspective, seeing a physician a few times a year is not enough. This was my inspiration for the “first mile” idea, of offering frequent neighborhood-centered wellness counseling sessions within a 10-minute drive of a person’s home to promote lasting lifestyle changes.
First Mile Care specializes in the CDC’s Diabetes Prevention Program (DPP), a year-long lifestyle change program clinically proven to reduce risk of developing type 2 diabetes by 58% (and 71% for age 60-plus). We act as a complementary extension of a physician’s practice to offer diabetes prevention classes with a limited touch.
Partnering with physicians, we recruit both the participants and also experienced wellness coaches with local ZIP-code knowledge that we train in the DPP. Coaches counsel patients both one-on-one and in group settings on healthy practices to create small, sustainable habit changes, covering not just eating and meal planning, but fitness, stress management, mindfulness, triggers, and motivation.
2021 and 2022 threw a lot of curve balls into business on a global scale. Based on the experience gleaned in the past couple years, how can businesses thrive in 2023? What lessons have you learned?
Karl Ronn: A lesson that I think we all learned from the pandemic is the importance of community and authenticity. Sure, it’s easy to do Zoom calls and Facebook chats but in the end, we all want to connect with each other face-to-face. We’re starved for real, authentic connections.
COVID-19 forced First Mile Care to move from giving in-person classes to online. So, we’ve had to learn about both modes of learning. The key takeaway is that in-person is the gold standard. Digital is an enabler for the back-office automating and lowering of costs, but digital can lead to mere class auditing rather than focused participation that results in lifestyle change. Some people can be as effective online, but the accountability of showing up for others is a next-level commitment.
The weigh-in moment focuses on the progress the participant has made or is a natural point for making a new plan. Net, we are excited to be bringing people back to meetings face-to-face, and people tell us how much they have missed the live connections.
That’s why First Mile Care chose to build out programs in participants’ neighborhoods — the “first mile” where people live is the important mile. Eating better and exercise is theoretical if we don’t embrace the actual constraints to good health that people face. Good or poor grocery stores, hot or cold weather, all the beauty of ethnic diets. So we connect people who live in the same neighborhood and allow them to learn from each other, facilitated by a coach. They get the information they need, but ultimately build lasting bonds with others on the same journey to creating a healthier lifestyle.
The pandemic seems to keep on disrupting the economy, what should businesses focus on in 2023? What advice would you share?
Karl Ronn: Be agile and don’t look back. This post-pandemic period is a new, second disruption. What worked before and during the height of COVID-19 is not what will work now.
We need to keep experimenting to find new hybrid solutions. The future is more like what we already take for granted in media and shopping. We seamlessly move between online and in-person shopping, streaming and old media (including Facebook). That seamless blend is now changing healthcare and every other business. People are more ready to embrace hybrid solutions than either corporations or managers.
How has the pandemic changed your industry and how have you adapted?
Karl Ronn: There are currently 96 million Americans, or 38% of the adult population, with prediabetes and thus at risk for developing type 2 diabetes. That number keeps rising and the isolation of the pandemic hasn’t helped. Multiple recent studies have shown that not only is diabetes a high-risk comorbidity for COVID-19, but people who have recovered from COVID-19 may also be more likely to be diagnosed with type 2 diabetes at a later date.
The research is still emerging, but it adds to the long list of chronic illnesses associated with diabetes, such as heart disease, stroke, kidney damage, blindness, and dementia.
What advice do you wish you received when the pandemic started and what do you intend on improving in 2023?
Karl Ronn: The pandemic slowed down decision making in health systems and insurance companies. At First Mile Care, we prioritized the participant experience design and platform for generating supply of classes, and generating demand through activating healthcare registries. It turns out that the move to online classes was easy, although providing an inferior participant experience.
If we had foreseen the pandemic, we would have hired more commercial resources to get the health payors and providers under contract before they got distracted. Having that larger team costs more money but would have paid out. In 2023, we are focused on those commercial issues as we return to offering fully in-person programs.
Online business surged higher than ever, B2B, B2C, online shopping, virtual meetings, remote work, Zoom medical consultations, what are your expectations for 2023?
Karl Ronn: The CDC-backed Diabetes Prevention Program is clinically proven to work but isn’t yet reaching millions of people. Everyone wants to tackle this problem digitally because that’s the newest thing. At First Mile Care, we are embracing the opposite. Next year is all about being back together face-to-face with other people. Pandemic teaching was a disaster for students; the same is true for adults when habit change is involved.
We believe in working at a hyper-localized level, with an in-person, face-to-face program in every ZIP code, within 10 minutes of a person’s home. We believe that’s why the DPP works, as it offers coaching with a peer group and 12 months of personal action planning along all the dimensions required for success. We believe community support is one of the most powerful success motivators, so sharing your goals with a friend or a family member (or other DPP group participant) that you see in-person on a regular basis will help keep you accountable towards your goals.
During the pandemic shutdown, we had to move to online Zoom meetings, of course, but have been transitioning back to fully in-person classes as new groups kick off. We feel it builds more authentic, deeper, lasting relationships among participants, which in turn leads to more sustainable lifestyle changes.
How many hours a day do you spend in front of a screen?
Karl Ronn: Our organization is distributed across the U.S. with the core in five states. That means lots of screen time. A lot of work can be done with a phone versus a screen. So, I try not to use Zoom when I can drive to see someone at the office or don’t need to share a document. Nevertheless, I must spend 5-6 hours a day at a screen.
I follow the Diabetes Prevention Program guidance on physical activity and get at least 150 minutes of moderate exercise each week. Exercise is a key component in helping the body control its blood sugar level and insulin sensitivity which can lead to a chronic illness like diabetes. I’m located in Menlo Park, near Stanford University, and given our mild weather, I have walking meetings quite often or meet at a coffee shop. Changing the scenery clears the mind and reduces stress.
The majority of executives use stories to persuade and communicate in the workplace. Can you share with our readers examples of how you implement that in your business to communicate effectively with your team?
Karl Ronn: Every company has a founder’s story and a growth story. Together, they capture the mission and a path for growth beyond what the founders imagined. As the founder, I share what inspired me to create the company. Dr. Karen Kmetik of the American Medical Association (AMA) described to me the early success the CDC and AMA were having in getting the first 60,000 people to take their diabetes prevention class. But the scaling was stuck.
I made an off-hand comment that if this were a consumer product, we’d set a 10-year goal of getting half the people in the market — by doubling every year. That is done by removing the different barriers to doubling every year. Never be incremental. My comment led to a nearly 2-year journey of working with the CDC and AMA to identify the barriers, and then we founded First Mile Care to remove those barriers. Imagine defeating diabetes for the next generation!
Our team works on the growth story. They have very diverse experiences in different parts of the healthcare system. They bring those new stories to address our problem and together we create that new storyline.
Business is all about overcoming obstacles and creating opportunities for growth. What do you see as the real challenge right now?
Karl Ronn: The biggest obstacle to preventing diabetes is the lack of focus on prevention. Chronic disease management drives almost 80% of total healthcare costs. So, investment goes to cost reduction for the people that have diseases. It is far easier to make money by saving money. Those returns show out with historical analysis of last year’s bills. Prevention pays out in the future and insurers, employers, or healthcare systems might not be the ones who reap the long-term benefit. As a result, prevention looks like a short-term cost if your time horizon is only one to three years.
Prevention is important but not urgent. Diabetes costs $11,000/year and prevention costs $700 one time. The math is simple, but the incentives are not there to do it because it isn’t as profitable as saving money on the big items you paid for last year.
In 2023, what are you most interested in learning about? Crypto, NFTs, online marketing, or any other skill sets? Please share your motivations.
Karl Ronn: Our needs are more mundane than the flashy stuff that makes the headlines. First Mile Care started as a form of public-private partnership. The Centers for Disease Control (CDC), Centers for Medicare and Medicaid Services (CMS), and the American Medical Association (AMA) created the Diabetes Prevention Program to stop the diabetes epidemic. First Mile Care brings operating, financial, and marketing experience that is complementary.
I still don’t know enough about navigating the public sector. Given our mission, we need to learn how to tap into the grant programs or other resources that could help us reach more people with our program.
A record 4.4 million Americans left their jobs in September in 2021, accelerating a trend that has become known as the Great Resignation. 47% of people plan to leave their job during 2022. Most are leaving because of their boss or their company culture. 82% of people feel unheard, undervalued and misunderstood in the workplace. Do you think leaders see the data and think “that’s not me – I’m not that boss they don’t want to work for? What changes do you think need to happen?
Karl Ronn: My advice: Spend time with the people on the front lines. Enable them, learn from them.
Our workforce at First Mile Care is almost all part-time. That’s because people can typically only take a habit change class after work on Tuesdays, Wednesdays, and Thursdays. Or, if retired, they might be able to do a morning or afternoon on those same days. Net, there isn’t a 40-hour workweek for a coach. Additionally, we do outreach on behalf of physicians to educate people with prediabetes and enroll them in class. This, too, only happens at certain times of the day.
The coaches and the assistants who do the enrollment are wonderful, caring people. They want to help others. First Mile Care ends up being only part of what they do, working around other priorities in their life, such as raising their children. We therefore provide flexibility for them that many other jobs don’t. These factors help us attract people to do an important task — preventing diabetes.
We try to do all company meetings via Zoom. I personally meet all the coaches via Zoom if I’m not able to get to their city in person before they start with us. I ask them to tell me, “If you were me, what should I do?” I also apologize for any challenges with our onboarding process, and thank them for their patience as they get up to speed. People who choose to help others for a living are nice, kind people. We try to pay as much as we can to the frontline folks while minimizing the back-office costs. That’s what it takes to do prevention.
On a lighter note, if you had the ability to pick any business superpower, what would it be and how would you put it into practice?
Karl Ronn: My business superpower would be the ability to make people care about preventing disease versus reducing the cost of managing current disease. Our current value calculations are backwards-looking versus options analyses that value the future. Maybe I’d be like the three ghosts (Past, Present, Future) in Dickens’ A Christmas Carol.
What does “success” in 2023 mean to you? It could be on a personal or business level, please share your vision.
Karl Ronn: From an executional perspective, there are 644 counties in 15 states the CDC has identified as having a higher incidence of type 2 diabetes.
While First Mile Care started out in the San Francisco Bay Area, we’ve found great success in the metropolitan areas of Houston and Detroit, which have larger communities of at-risk populations for diabetes than does the Bay Area. Each market becomes a model for reaching other cities. We’ve now moved into Syracuse and are looking to expand in Chicago and in the California Central Valley in 2023.
On a vision level, we got into the diabetes prevention business because it wasn’t scaling. Our supply and demand model is now validated as a way to do scaling, but scaling isn’t taking off as fast as we would like. So now we are working on tech platforms and lower-cost ways to enroll people. We need those capabilities because we could triple in size in 2023 and must be ready to triple again in 2024. Being tenfold bigger by 2025 requires us to invest in the fundamentals now.
Jed Morley, VIP Contributor to ValiantCEO and the host of this interview would like to thank Karl Ronn for taking the time to do this interview and share his knowledge and experience with our readers.
If you would like to get in touch with Karl Ronn or his company, you can do it through his – Linkedin Page
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