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Where tech meets 'people solutions': a conversation with Karoo Health CEO, Ian Koons

Ian appeared on the Venari Podcast’s HealthTech CEO series

When he was a teenager, Ian Koons’s parents told him to get a job – ‘a real job’ – during the summer holidays. He had other ideas, however, so he set up a curb painting business with a friend. ‘We would work half the summer, and then spend [the other half] at the pool,’ Ian recalls. ‘So, I think from an early age there was that entrepreneurship bug.’ Ian’s father was a physician, and seeing the time and effort the doctor put in – not to mention the gratitude of his patients – would eventually inform Ian’s career choices, as the Karoo Health CEO told our Digital Health Consultant, Cristian Owen, in this episode of the Venari Podcast’s HealthTech CEO series.


A personal connection to cardiovascular disease

Despite his father’s medical background, Ian’s first professional venture was in the world of sports before he moved into healthcare. A conversation with the founder of the CRO Elligo Health Research would prove influential in determining Ian’s direction. ‘He was talking to me about wanting to do something in cardiovascular care, really stemming from the disjointed, unsupported experience [his] dad had with cardiovascular disease. And it just so happened my best friend had a heart attack and passed away at 29.’ Ian had always wondered if he could create technology and/or a care delivery system that might have prevented such losses, and so Karoo Health was born.

Value-based care

Ian and his co-founder, Chad Moore, did extensive research on cardiovascular care, during which time he met Mark McClellan, a former Centers for Medicare & Medicaid Services administrator, who had been commissioned by the American Heart Association to study the worsening outcomes for cardiovascular disease in the U.S., as opposed to other disease states. ‘Unsurprisingly, the results of that were there’s no value-based care, and kind of general misaligned incentives with providers,’ Ian notes. The Karoo founders went on to spend the best of a year speaking to cardiologists, asking them about the delivery model they would build with unlimited time and resources. The universal outcome was that it would need to be a hybrid model, ‘whereby we’re really enabling value-based care from a traditional volume-based [model] to a value-based through our wraparound services and the technology in which we deploy.’ Karoo launched their first state earlier this year, and recently released their second state offering.

For Ian, the term ‘value-based care’ is like ‘marketing’: ‘it’s just a broad word that can mean so many things. To me it really means an alternative payment model to the current system.’ The mechanisms and approaches can and do vary, but the fundamental point remains rethinking the current fee-for-service model that is currently the norm in this sector – and proving that this system can flourish will be key to Karoo’s efforts over the next few years. It’s working for them so far, at least; Ian notes that they are one of the U.S.’ most important specialty healthcare companies and have become synonymous with cardiovascular care domestically. Still, as with any relatively new business, there have been difficulties – mostly, trying to convince partners that their delivery model can work well without damaging income or clinical workflow, and that it can in fact enhance customer experience, revenue, and, most importantly, patient outcomes. Their first partners were a little skittish at getting involved with this unknown quantity, though Ian notes that they have since solved these issues and ‘those conversations have gotten increasingly easier’ as they go forward.

Professional applications

Indeed, Karoo are now at a point where numerous cardiologists around the country have reached out directly for help with this model of care, and they hope to see the number increasing. Ian credits some of this to word of mouth and press coverage, though he also believes doctors’ ‘internal moral quandary’ of knowing that patients will end up back in the emergency department no matter what the physician recommends, also plays a part. He cites one cardiologist in New York, who had 55 cardiac admissions to his clinic in one weekend, as an example: ‘When you ask him, they don’t feel good about this, they say 50-75% don’t need [to come in].’ Still, as long as cardiovascular disease lacks mainstream wraparound services and streamlining technology, Ian believes that such scenarios will continue to occur.

Advice for HealthTech founders

Given how fast things are moving for Karoo, Ian is well placed to give advice to the HealthTech founder of tomorrow. One essential recommendation is to ‘do something that you either are an expert at or super passionate about. Because ultimately you’re going to be spending all day, every day, every night thinking about solving this issue.’ Ian also stresses the need to be resolute and focused on your ultimate goal – to let criticism ‘roll off’ you – as there will be no shortage of people to tell you that ‘you’re dumb’ or that you can’t do something. Separately, he mentions learning simple things the hard way – like firing poor performers after six months, rather than three, at his first startup. ‘It’s actually better to have those conversations sooner for everybody, and make sure everybody is aligned and pushing in that direction, rowing the boat together.’ This is especially important in light of Ian’s belief that technology alone will not ‘solve healthcare’; rather, that ‘tech and people solutions’ working together can remedy many real-world healthcare issues.

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