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Joanna Strober & Munjal Shah

This Week In Startups - Episode #522
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Background
This is a two-part episode from the Rock Health Summit first with Joanna Strober, Co-founder and CEO of Kurbo Health, which is a platform to help fight and prevent childhood obesity using video and text-based one-on-one coaching. Previously, Joanna was a Managing Director at an investment management firm and was a partner at Bessemer Venture Partners where she made consumer internet investments. Joanna has been featured on the front page of the Wall Street Journal for her work with many well-known and successful companies including Blue Nile and BabyCenter.

The second part of this episode is with Munjal Shah, Founder and CEO of Health IQ, which measures not how healthy someone is, but rather how health conscious they are using a Q&A app with 10,000+ questions across 300+ topics. Prior to Health IQ, Munjal was co-founder & CEO of Like.com (computer vision/machine learning company sold to Google) & co-founder & CEO of Andale (eventually sold to Alibaba). He is also an investor in numerous companies like Taskrabbit and Swell.
Key Takeaways - min read
 
Top Quote:

 "40% of all kids in the United States are overweight or obese."

- Joanna Strober
 
Key Takeaways:
 
Part 1 - JOANNA STROBER

Kurbo Health

Most of Joanna’s life was spent as an investor. Kurbo Health is her first company. 

Kurbo Health is the only safe and effective weight management platform for kids and teenagers to help them lose weight. 

Joanna started this company because she had an overweight kid. 

When the kid is younger Doctors will say they will outgrow it, and then they are very good at telling you that you have a problem once the child reaches a certain age.
  • They are not good at offering suggestions on how to fix the problem. 
Kids come into the office and hug Joanna and her team, and say they changed their life. 

Each kid is given a Coach that will communicate with them however they choose (text, email, FaceTime etc.). 

Kurbo follows the traffic light diet, created by Len Epstein who is also on the advisory board.
  • Instead of counting calories, all food is classified as red, yellow or green based on caloric density. 
  • Joanna’s son lost 18 pounds using the program. 
Kurbo launched to the public in September 2014.
  • There are hundreds of kids paying $75 a month to do the program.
  • There is also an app for older kids who don’t need the coaching as much, and tens of thousands of people have downloaded that app. 
There are different packages where you can talk to a coach versus just getting texts.
  • Text coaching is $25 a month. 
The research is terrifying. For boys who are overweight - it has the same effect on their income potential as not going to college.
 
With women, the more overweight you are the less likely you are to have a good job.  

People can sign up for and use Kurbo right now.
 
Kurbo is also working with some health plans doing pilots in a hope to eventually get some insurance coverage for it. 

PART 2 - MUNJAL SHAH

Health IQ

Health IQ (name recently changed to Hi-Q) measures not how healthy someone is, but rather how health conscious they are using a Q&A app.
  • Health conscious is a measure of your health literacy. 
There are 10,000 questions on 300 topics calibrated with half a million people in the app. 

One million plus dollars was spent on writing the questions in the app because they were all certified by experts in each respective field. 

Your health IQ actually correlates with a 50% reduction in hospitalizations in the past year even if you control for age, gender, and income. 

This is the first way in the world to measure your health literacy.

How the app will make money hasn’t been determined yet.
  • Revenue opportunities will come from aggregating this very economical viable group. 
Munjal created this company because the day after he sold his last company he ran a 10K race and ended up in the ER with chest pains.
  • It didn’t end up being a heart attack but they couldn’t fully figure it out and he realized that he needed to change his health. 
Between nutritional, medical, and exercise knowledge - medical knowledge had the least correlation to keeping you out of the hospital. 
  • Practitioner knowledge is the most predictive of keeping you healthy.
Table of Contents (Full Notes) - 13 min read 

*You can use the table of contents links below to jump to that section only on laptop and desktop.*
Part 1 - Joanna Strober Part 2 - Munjal Shah
Top Show Links

Background Companies  People Miscellaneous
 
Part 1 - Joanna Strober
On Joanna's Background
Most of Joanna’s life was spent as an investor. Kurbo Health is her first company.
  • She invested in BabyCenter and eToys. She was also on the board of Blue Nile.
Her first investment was in a company called FlyCast with Rick Thompson.
  • He was out of money and Joanna called him and now he is one of the most successful guys out there with 5 companies after that.
When she wanted to get Kurbo Health funded, she went to him and Signia led the Kurbo investment round.
On Kurbo Health
There was a group of 15 kids on the advisory board who helped pick the name.
  • They had all lost weight in different ways and they chose the name.
  • It is a combination of “turbo” and “curbing”
Kurbo Health is the only safe and effective weight management platform for kids and teenagers to help them lose weight.
 
If you look at the world of weight loss and whether it’s MyFitnessPal, WeightWatchers, or Jenny Craig they are all 18 and over.
  • Kurbo is the only one proven safe and effective for kids under 18.
Joanna has a co-founder (who was a lead behavior coach at the Stanford pediatric weight control program specializing in coaching families to have better eating habits).
  • They originally licensed Kurbo to this Stanford program.
It is an in-person program where you go and meet with people and have a paper-based food diary.
  • Joanna turned their entire process into an app with mobile coaching. 
On Weight Loss For Kids
There is a calorie counting issue when it comes to weight loss for kids. 
  • No one wants kids to count calories.
When Joanna’s son looked at MyFitnessPal, he said “oh I can have 1,500 calories, that’s 5 bags of potato chips or pretzels.”
  • Kids need to eat healthier rather than counting calories. 
Parents Of Overweight Kids
40% of all kids in the United States are overweight or obese.
  • Some of it, especially with very young kids, is the parents’ fault.
At some point it does become both the parent and the kid.
 
Joanna started this company because she had an overweight kid.
  • She had three kids and only one had a weight problem.
For her, she had to make some changes. Her kid was eating a lot of smoothies, which most people think are healthy, but they have a lot of calories - same thing with white bread.
 
You think overweight kid and immediately think Coke and McDonalds, but in reality it is a lot of things- juice, bread, yogurt, and all the foods the kids are fed all the time that aren’t necessarily unhealthy, but are really high in calories.
 
Doctors will tell you that your child will outgrow being overweight up to a certain point.
  • They are very good at telling you that you have a problem once the child reaches a certain age, but are not good at offering suggestions.
As a parent you are left trying to figure out what to change on your own.
Kurbo Health Success
Kurbo Health’s Clinical efficacy is much better than ever expected.
  • Kids come into the office and hug Joanna and her team, and say they changed their life.
Each kid is given a Coach that will communicate with them however they choose (text, email, FaceTime etc.).
  • That coach is the support system and they give constant feedback.
Kurbo follows the traffic light diet, created by Len Epstein who is also on the advisory board.
  • Instead of counting calories, all food is classified as red, yellow or green based on caloric density.
  • Initially you count how many reds you are eating and slowly reduce them.
The kids get to choose what reds they eat so they are empowered.
  • Joanna’s son lost 18 pounds using the program.
The food police role is put into Kurbo and instead you have a supportive system that helps you to lose weight instead of your parents or the doctor making you feel bad.
 
One girl lost weight on the program just from cutting out Odwalla’s juice, which has more calories than Coke. 
On Parent Involvement
The Kurbo team hears from the kid what red foods the parent is bringing into the house and they text the parent suggesting to stop bringing that food in.
  • It is a family issue and things can’t change without getting the whole family involved.
Some parents don’t want to do it and Kurbo can help that kid regardless, but there is much more success when the parents are involved.
 
Eating healthy is more expensive then eating poorly is only true to some extent.
  • But you can help by just drinking water instead of orange juice or Coke and that itself saves money.
There are basic things that don’t cost any more money. 
On Kurbo's Business Model
Kurbo currently acquires customers advertising on Google saying “help your child lose weight.”
  • When people used to come to the website and saw the words “lose weight” they didn’t want to show it to their child.
Parents do not want to tell their children they are overweight.
 
Now Kurbo doesn’t talk about weight but rather about the personal health coach and downloads went way up.
 
Kurbo launched to the public in September 2014.
  • There are hundreds of kids paying $75 a month to do the program.
There is also an app for older kids who don’t need the coaching as much, and tens of thousands of people have downloaded that app.
 
There are different packages where you can talk to a coach versus just getting texts.
  • Text coaching is $25 a month.
A lot of the parents start with the text coaching and that works for a while.
 
Then they need extra motivation and upgrade to the talk coaching.
  • You also see the opposite.
Regular coaching can be video or just audio.
 
Sometimes a kid will say they haven’t exercised this week because it is cold out, so Kurbo coaches will send them an exercise video and ask them to try that.
  • Or say to make a deal with Mom to just go walk the dog four times this week.
Kurbo encourages starting with 3 months, and is finding that people stick with it after that.
 
Adult programs charge about the same as Kurbo does for their kids program.
 
One thing that is different, if you look at Vida or Rise, they are marketplaces so they aren’t spending the time training the people.
 
Kurbo is talking to children, and parents do not want random people talking to their kids, so coaches are put through intensive training programs and have strict guidelines around who is able to work as a coach.
 
Customers have one phone call and as many texts as they want. 
On Weight Psychology
It was a challenge and a lot of the marketing had to change around using the words “weight loss.”
 
Parents think they will give their kids a self-esteem problem by mentioning weight, but those kids already have a self-esteem problem.
  • The research is terrifying. For boys who are overweight - it has the same effect on their income potential as not going to college.
  • With women, the more overweight you are the less likely you are to have a good job. 
You have to think about it in terms of helping their overall development and career potential by helping them to lose weight.
 
For kids who lose 25 or 40 pounds at age 12, it truly changes their life.
 
It changes how people treat them. They are able to do well in PE so they aren’t embarrassed anymore. The benefits are enormous.
 
It is amazing that Kurbo is the only thing out there for this issue. 
On Morbid Obesity
At some point, people may need more help than Kurbo can offer so they refer people to therapists for additional help.
 
The goal is to get people before the morbid obesity point.
 
At some point it becomes much harder to change who you are, so targeting kids early is more effective.
 
They used to give kids BMI score on their report cards in 17 states.
  • They would send “fat letters” to the parents, but they provided no tools to lose the weight.
The goal is to have Kurbo be one of those suggestions to help.
On Kurbo Coaches
Coaches all start working in the  Kurbo office.
 
All communication between the kids and coaches is monitored.
If the child is an athlete they are matched with a coach who is one too.
 
Most people want a female coach.
  • 12 and 14 year old boys do tend to want male coaches though.
  • Girls only want female coaches.
If the Dad is able to join the coaching sessions, Kurbo has found great success.
 
A lot of the time it is the Moms searching for this and signing the kid up, but if the
Dad gets involved that is when the highest weight loss is happening.
 
Parents tend to Google “exercise” instead of “weight loss” which seems to be a code word.
 
Research shows that 90% of weight loss is the food not the exercise.
 
Parents tend to think if they get their kid to exercise more they will lose all the weight, but it usually comes down to the food they eat. 
Kurbo Health Future
People can sign up for and use Kurbo right now.
 
Kurbo is also working with some health plans doing pilots in a hope to eventually get some insurance coverage for it.
 
Kaiser is recommending it. 
  • Kurbo is actually showing a reduction in diabetes risk and the numbers are powerful.
Insurance right now covers bariatric surgery, which is rapidly growing in kids, but they don’t cover weight loss programs.
 
It is not about looks but it is about the fundamental health of the child.
  • Kurbo wants to be that thing that people try before they get to the point of needing surgery.
Kids are even seeing fatty liver disease these days.
 
That did not used to happen until people were 70.
  • Now Kurbo is doing a trial with kids between 10 and 13 with the disease. 
On Rock Health
Rock Health was amazing. Halle and Malay from Rock Health are two of the smartest and best people to work with.
 
Joanna did not know a lot about healthcare and was given a lot of important introductions through Rock Health.
 
The network of companies is also very powerful. There is a lot of good interactions between the companies and being supportive of each other.
On Female Venture Capitalists
Being a woman in the 90’s in venture capital it was about people not taking you seriously.
  • There was clearly a boy’s network that really did help each other that the women were not part of.
If you look at the other women who were VCs are that time, pretty much none of them are doing it anymore.
 
If you look at the top 10 venture funds there are just about no women in them.
  • Maybe just a few. 
On Female Founders
The founders at Rock Health companies are some of the most extraordinary women Joanna has ever met.
 
In certain areas like digital health, women are being more successful and Halle Tecco has been a major factor in facilitating that.
 
Joanna has three kids. The last thing she would do is go to a speaking agent if it was a waste of time.
  • Your time becomes very precious so you learn to focus where you are most effective.
Part of it is that you feel very grateful to have been given the chance and don’t want to mess it up. 
Part 2 - Munjal Shah
On Health IQ
Health IQ (name recently changed to Hi-Q) measures not how healthy someone is, but rather how health conscious they are.
 
Health conscious is a measure of your health literacy.
 
Things like:
  • knowing gin and tonic actually has 20 grams of sugar in it from the tonic water.
  • knowing the best natural remedies to manage arthritis.
  • knowing about cyber bullying and the best way to protect your child and manage their mental health.
Everyone is trying to measure heart rate and number of steps per day, but there is actually a step that comes before that. 
 
Knowing isn’t doing, but you can’t do what you don’t know.
 
The first step to increasing your overall health is increasing your health literacy.
 
There are 10,000 questions on 300 topics calibrated with half a million people in the app.
 
What they were trying to figure out from a big data standpoint was that all health facts are not equally important.
 
Knowing some things might impact your health more than others.
 
You go through the quiz in the app and get a percentile.
  • A third of users in the first 14 days spend 170 minutes taking 500 questions.
The app appeals to the “Chief Health Officer” of the family who wants to know what they know because they take care of everyone else.
 
It shows the topics you score in the top 90th percentile on, your elite topics and a balance between nutritional, medical and exercise. 
On The Health IQ Questions
One million plus dollars was spent on writing the questions in the app.
 
Researchers wrote them and they are all certified experts in each area.
  • For example the head orthopedic surgeon for the US Olympic team certified all the sports injury questions.
If you are going to test someone’s health IQ, the key thing that matters is giving them a test to test their deep knowledge, not shallow knowledge.
  • For example, asking whether dark chocolate is better than milk chocolate tells nothing because that has been blasted through the media.
  • Asking you to self- assess how many times a week you drink tells nothing because the user will lie.
But asking how many pounds an Olympic barbell un-weighted is will tell a lot.
 
Another example is asking if it is proper etiquette to drink water in the first 30 minutes during bikram yoga.
  • These are things that you only know if you have done it.
These types of questions are not only predictive in assessing your health knowledge, but also assessing your actions because you only know it if you did it.
 
Your health IQ actually correlates with a 50% reduction in hospitalizations in the past year even if you control for age, gender, and income.
 
This is the first way in the world to measure your health literacy.
 
This civilization has spent 100 years working on literacy. The next 100 years should be focusing on health literacy.
On The Health IQ Business Model
How the app will make money hasn’t been determined yet.
           
Munjal created this company because the day after he sold his last company he ran a 10K race and ended up in the ER with chest pains.
  • It didn’t end up being a heart attack but they couldn’t fully figure it out and he realized that he needed to change his health.
He lost 40 pounds, but realized that didn’t come from counting steps or checking his heart rate, but rather knowledge and nutrition.
 
So the idea came for coming up with a new way of assessing everyone’s health literacy.
 
In this process they are aggregating all of the health literate people.
  • Those are the people who use it, come back to it, and check the daily topic.
A lot of the current health companies/apps are on a fool’s errand.
 
They are trying to get the people who don’t care about their health to care.
 
You have to think about the market from the perspective of those who don’t care, those who newly care but don’t have the skills, and the highly conscious.
 
The best ROI for healthcare focus and spend is not on the first group, but rather the second group – the ones who have raised their hand and said I want help and care now, but don’t have all the skills.
  • There will be more impact on total healthcare dollars in the entire country by focusing on these people.
Revenue opportunities will come from aggregating this very economical viable group.
 
There is 10 billion dollars in gluten free sales a year, there is 100 billion dollars in natural food sales a year, etc.
 
Advertising is one angle, but there might be something better than that because advertising doesn’t feel like the right answer.
  • They have looked at having insurance companies do this and are working with some big ones now.
They have an HRA (Health Risk Assessment) they hand to you when you first see a doctor.
 
It is a standard form but no one likes taking it and most people lie.
  • Jason mentioned he thinks the angle is lead generation. When you are going through all these questions, you are qualifying leads. If someone is a diabetic and goes through a quiz on a certain subject you could provide a doctor or a drug or more information.
But with this group you are finding the diabetic that really manages their disease well.
 
On of the Health IQ advisers, Martin Abrahamson, the Chief Medical Officer at the Joslin Center for Diabetes at Harvard, noted that the two places diabetics go most wrong is in pizza and Chinese food.
 
There are also a lot of caregivers who use the app.
  • Jason mentioned he thinks he has a lead generation machine here. Jason is an investor in Thumbtack. Things like that and Taskrabbit, those leads are worth something.
In general, all of the successful health consumer apps are hitting the same audience of health-conscious people.
 
The people who are wearing Fitbits are pretty health conscious.
  • This app identifies them and keeps them learning 
On Doctor Knowledge
Between nutritional, medical, and exercise knowledge - medical knowledge had the least correlation to keeping you out of the hospital.
  • Knowing that insulin is made in the pancreas does not help you manage your diabetes anymore.
But knowing at Chipotle which tortilla to order that has the lowest amount of carbs (insulin spike) in it actually does.
 
The questions in this app are practical. Such as “how do you eat gluten free at Wendy’s?” 
 
Practitioner knowledge is the most predictive of keeping you healthy. 
On Health IQ Investors
George Zachary from CRV has invested in Health IQ.
 
He was an investor in Munjal’s first company Andale, which started in 1999 and sold to Alibaba in 2004.
 
Then in 2005 Munjal started Like.com. Like.com started as a different technology.
 
It was a product called Riya and was face recognition for organizing your personal photos, and then they eventually pivoted to the idea that Google bought.
On Like.com
Munjal owned Like.com before there was a “like” button, and bought it for $100,000 in 2005.
 
Some guy in San Francisco had the domain and wasn’t responding to any messages, so Munjal and one of his execs went to the guy’s house, left him a bottle of wine and an article about the company.
  • He asked for cash and they sent it.
Like.com was a visual search engine.
 
It used machine learning to look inside photographs using color, shape and pattern.
 
Google bought it because they wanted the technology for product search.
  • They also bought the whole set of domains for every English speaking country.
On WebMD
  • Jason mentioned that Health IQ is going up against WebMD, who has 50 apps.
Munjal does not believe they are going up against WebMD because no one has built a calibrated app that actually assesses your health knowledge.
 
There is also a discussion board for every topic.
 
In the discussion board, every time you post, the number of points you got on that subject’s quiz is posted next to your comment.
  • This is the only verified health discussion platform available. 
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