This week I am talking to Jeff Ruby, Founder Newtopia (@newtopia), a company using a combination of genetic testing, nutrition, and personal, technology-enabled coaching can change habits that modify life-impacting behavior as a critical part of the solution
Jeff shares his origin story of when his father was diagnosed with abdominal cancer and how this experience pushed him to move into the healthcare space focused on lifestyle and genetics and how we turn our sick care system into a well-care system
We talk about the importance of habits and changing people’s behavior and how difficult this is given the weight of thousands of years of adaptation that has made us select many of unhealthy options because we now live in a world of comparative plenty. As he describes it we are humans in a casino and the house is currently winning but we need to start tipping the odds back in favor of our health
Newtopia is a habit-changing company that has managed to customize its approach to each individual, learning about each individual, and their social environment, social determinants, and behaviorally from a personality, motivation, and readiness to change perspective. They have a novel and interesting approach to the genetic component pioneering an area they call genetic engagements, which is not using genes to identify ancestry, or disease risk but answering the question for the individual, do have they inherited factors from their parents that could be impacting their weight and lifestyle, so they can stop blaming themselves
Listen in to hear Jeff talk about their ‘Inspirators’ and how they manage to achieve success by capturing attention by providing the nudges and insights at the right time to effect change.
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Raw Transcript
Nick van Terheyden
And today I’m delighted to be joined by Jeff Ruby. He’s the founder and CEO of new topia, Jeff, thanks for joining me today.
Jeff Ruby
Wonderful to be here, Dr. Nick, thank you for having me.
Nick van Terheyden
So if you would share us a little bit of the background to your story and how you arrived at this point in your career, and nutopia
Jeff Ruby
Sure, I would characterize myself as a bit of an accidental Health Innovation person, I didn’t start out in this direction, I did a JD MBA and thought I was heading toward a career in corporate law of all things and found myself fairly miserable in that vocational choice. In the same week that I chose to resign and find something to do something to do found me it was a call from my dad, who had been diagnosed with abdominal cancer at 54. And it was really his experience was my awakening to this realization that what we call health care, often doesn’t have a lot to do with keeping healthy people healthy, and has much more to do with managing illness as it comes much more of a sick care system. And I was struck by that through his experience. And then the next major aha moment came sitting in the oncologist office with him. My dad’s first question was, Doc, how did I get this? And I’ll never forget the oncologist responding with you know, Mr. Ruby, a lot of this has to do with some unlucky genes and your lifestyle choices, which in that moment, I have to admit, I wasn’t sure I understood what he meant. But I certainly knew that I may share some of those unlucky genes, and may not understand what healthy lifestyle, lifestyle choices mean for me to avoid sitting in that chair. And so that’s led me on a 20 year odyssey now of four startups, all trying to understand the genetic equation, the lifestyle equation, and more importantly, how can healthcare be more about keeping healthy people healthy as a first instance, both for the benefit of individuals, and ultimately, for the benefit of health insurers who are financially responsible for those individuals. And I think there’s a win win win here, and I’m really striving to find,
Nick van Terheyden
you know, it’s a first of all, sorry to hear about your dad, I think that’s always a challenge, you know, for any son or daughter, when their parents, you know, suffers disease, I’ve certainly been through that experience, and, you know, helping them navigate that is one of the special challenges that I think children have, and and struggle with. And even as a physician, that was a challenge for myself, so I can fully sort of appreciate the difficulties of that. But you started out by saying, you know, the, he wanted to know where it come from. And you know, it’s a contribution of a number of factors. And, you know, obviously, you share some genes with your parents, as we all do. That was a contribution, but there was also lifestyle. But that was a little bit of a mystery. Tell us a little bit about your exploration of that. And what you discovered along the way.
Jeff Ruby
Well, I really, yeah, I think, in many ways, were what I’ve been exploring. And in many ways, what we’re applying in Utopia is, of course, this concept that human health is, has got a genetic contribution, of course, as a social determinant contribution. And then there’s the choices we make each and every day. And what I’ve discovered is that there’s a lot of power, identifying within the best of science and evidence, some of the genetic understanding and genetic engagements that can help to shape those lifestyle decisions that we make understanding that they’re probably by far the most important considerations, especially when it comes to chronic diseases like obesity, or type two diabetes or cardiovascular disease, which are largely lifestyle driven. There’s of course, a genetic contribution. But it’s been that can we arm individuals with an understanding on the genetic side to help motivate, in in many ways, inspire the right kind of lifestyle choices? That’s been the formula that I’ve largely been seeing. And it’s been quite powerful in the arms of our participants who are experiencing some some pretty significant whole health changes as a result.
Nick van Terheyden
Yeah, and the other thing that you talked about was this wellness versus sickness or sick care, and I think that’s entirely right. Our healthcare system has been a sick caste system. I in historical context, that was because that’s what we knew. We’ve now sort of expanded this we now understand that, you know, those lifestyle changes can impact I mean, as I go back through my career, you know, I recall being told that 95% of the genome was junk. And, you know, the balance of it was, you know, contribution. And I also remember hearing very vividly you are a function of your genes. And that’s very much not true. We understand that, at least, I do. And I think, you know, generally that’s the case. So we’ve got lots of opportunity to change. But there is this overwhelming pressure that exists for humanity. And, you know, I, I boil it down to the hunter gatherer impact of 1000s of years of living in this world where we had very few calories. And now we’re in a circumstance where we’ve got lots and many of them are not good. But our programming, our preference is to pile in because the body says, Well, I don’t know when this is going to come up. So you’re essentially combating something that is extraordinarily difficult because of the sort of innate programming, how are you approaching that?
Jeff Ruby
So and I would just look, I would just say, and I say, with a massive amount of humility and deference, that I think our health care practitioners, physicians, like yourself, and health care workers, health systems, brilliant, fantastic, best in the world. But yet, haven’t had the focus on the human behavior, change the habit change, and the primary prevention side. And I think that’s where Newtopia is trying to come in as an adjunct. In addition, it’s not one or the other, I think it’s both. And in what we’ve been trying to do is really be there from an inspiration perspective, you’re right, the massive forces that you’ve just described, are very much present. And I oftentimes say it feels like humans are in a bit of a casino, you know, where you’ve got, you’ve got the nutrition, and lousy nutrition interests, you’ve got more and more immobility, and more and more distraction from screens and social media, tearing away at our attention to be outdoors and having mental health impacts. And unfortunately, the casino is winning. And in Utopia is trying to be a counterbalance force to that. It’s not an easy one. But it’s by betting on the individual and arming them with the right confidence, the right inspiration, and trying to tap into that intrinsic motivation for them, whatever that may be. And it’s something that’s being done, it has to be done one on one, it’s not something it’s not a course that can be taught. And it’s not something that can be I believe, algorithm to be applied there just through an app. But I think by tapping into that intrinsic motivation, and in by really learning about an individual genetically, socially, behaviorally, there’s an opportunity to really focus in on incremental habit change small tiny changes that effectively make the individual their, their their engine of success, they become a snowball. And that’s what we’re really here to create.
Nick van Terheyden
Well, of course, you’re singing my song. So I we’re going to be in violent agreement about those incremental changes. So that thank you for that. I absolutely concur with that. Tell us a little bit about what Newtopia does and how you go about it.
Jeff Ruby
Yeah, sure. I mean, at a high level, and utopia is a habit change company that’s working with health insurers today, whether they be self insured employers, or whether they be private health plans for fully insured populations, or Medicare Advantage populations. In together, we’re looking to prevent reverse and slow chronic disease, we’re looking to impact the cost of health care by doing so. And in many ways we’re trying to through these relationships we create help steer individuals to potentially filling some gaps in care or to impacting some quality metrics, which ultimately impact the health insurers a bottom line as well. What we’re doing is is becoming students have each individual at risk. And by being students, we are looking to learn about each individual, socially, from a social determinant perspective, behaviorally from a personality, motivation and readiness to change perspective. And where we’ve really done something novel is on the genetic side, we’ve pioneered an area we call genetic engagements, which is not using genes to identify ancestry. It’s not about disease risk, plenty of those opportunities out there, but it’s really trying to answer two fundamental class options for each individual. But first, have they inherited factors from mom and dad, that could be impacting their weight and lifestyle, namely, so they can stop blaming themselves? Because Dr. Nick, I believe that a lot of that blame that goes on that shaming and blaming is is a huge inhibitor for building confidence in having building new habits, right? If you shut down and believe there’s nothing you can do, then good luck trying to change someone’s behavior. But this, this idea that it’s not your fault is really powerful. And that leads to the second question we’re trying to answer, which is, how do we arm each individual with a greater sense of control over what to do about it? Effectively? How do we shape the macro recommendations in nutrition, and exercise in mental and emotional well being based on those genetic results all within evidence and guidelines to get the most amount of buy in to why we should do it in the first place? Again, how did the genes impact the lifestyle choices? And so with that learning underway, we then design, you know, this habit change framework, it’s all virtual. And there are a number of different components. There’s a human components, there’s technology, there’s the right wearable and wireless sensors, the right gaming, and the right social health communities, but all built one by one by one, it’s not a curriculum, we’re not teaching a course. And in so doing, each utopians experience is different. And the aim is that at the end of 12 months of that hyper personalized engagement, we want to see positive improvements to key physical risk factors, things like waist circumference, or BMI, blood pressure, blood glucose, triglycerides, cholesterol, we want to see key improvements to mental health risk factors, like anxiety, depression, asleep, and resilience. And we as a business go at risk for those outcomes as a performance based partner. So if we don’t deliver them, we don’t charge or we don’t get paid. And and ultimately, that’s really what Newtopia is doing to combat this habit change and prevent reverse and slow chronic disease.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Jeff Ruby. He’s the founder and CEO of new topia, we were just talking about the personalization of interaction and actually quite a unique approach to genetic. I think I’m right in saying testing that says, let’s find faults in those genes, which, you know, I haven’t heard that concept, but it makes a lot of sense. You know, it’s it, you’re right. It is nice to apportion blame to something that you can’t control. And you know, that’s contributory. I think an awful lot of people feel, in many respects, hopeless. I mean, you see this time and again, we saw, you know, a big expansion of this, I think, through the pandemic. As you think about your experience, you’ve been at this for a long time, obviously, I’m guessing that you like the rest of the world didn’t predict this pandemic coming. But arrived, what was the impact? And what did you see in your, your domain?
Jeff Ruby
Yeah, I think it’s, there have been two sides. I think the pandemic, in many ways highlighted the real challenge and risk of that at risk period. In many ways, in the sick care system, you generally have a focus on that 10 to 15% of the population with a diagnosed or diagnosable disease. And then the remaining group are sort of floating out there somewhere between worried well to at risk to, you know, going over the disease cliff, and I think the pandemic has helped to really focus on that 80% of the population at risk. I mean, when you think about it, that side from age, that group was the most impacted from a health and a cost perspective. You know, the, the staggering statistic from the CDC was that, you know, of the roughly American, excuse me, a million Americans who have passed away horribly from the, from the COVID pandemic 400,000, roughly 40% had type two diabetes. That’s a staggering number for a chronic disease that shouldn’t exist today, largely due to our lifestyle. And so I think in many ways, there’s been that shaping of the focus on at risk. But the second side is, I think the pandemic has also created a whole lot more risk. When you think about the multiple years we’ve now spent, distancing in some way, shape or form, probably eating in a worse fashion, maybe not being as active and with massive mental and emotional stress that continues today with burnout and great resign and all of the core corollary elements, that’s just creating more risk. And so for employers or for populations of insurers, that’s the Tinder for even greater physical and emotional risk factors. And unfortunately, I think it’s going to be unleashed a rather large tidal wave of more and more chronic disease in its wake.
Nick van Terheyden
Yeah, I think that’s absolutely right. And, you know, we have to find a way of changing that trajectory. And what I like about this approach is that the personalization of it, but at the same time, it gives me pause, because as I think about personalization, that typically adds time, cost, additional sort of impact in terms of being able to do that. And, you know, you described it almost as building blocks, are you able to do this and make it widely available and economical.
Jeff Ruby
So that I mean, really, that’s been the arts here. And, you know, we describe ourselves as a tech enabled habit change company, there’s a, there’s a lot of fantastic technologists in technology that enable that personalization so that it can be delivered, both at scale. And, and effectively to larger and larger populations. You know, today, we’re servicing some of the largest employer populations and insurer populations in the United States. And we continue to be very excited about these partnerships, and to continue to grow into them. And we’ve been constantly investing in more and more technology that will enable this handoff between the best of human and the best of digital understanding that at its core, I believe humans respond to humans in change in response to humans, so there must be a human component to it. But once that trust in that confidence is built in one another, as we’ve all seen, a few of us are having phone conversations with our friends and loved ones, it’s a lot more texting going on, once the trust is built, there’s a lot more shorter bursts communications, we too can mimic and do mimic that and offer more group dynamics as well. So yes, you know, I guess the answer is I do, we’ve built a platform by which we can scale and offer, you know, economics to make it affordable for the health insurer, very valuable to the participants. And ultimately, for us at risk. I mean, there’s a really viable business and a business model here as well.
Nick van Terheyden
So as you create a economic model, that, you know, starts to deliver this personalization. What are your input? I mean, how are you gathering the information to know what the habits are to change? What is what is your process to play intervention? How do you garner people’s attention through all this, because I don’t know about you, but I feel like everybody’s clamoring for my attention. And it’s hard to pay attention to the things that are important. And this is important, right?
Jeff Ruby
Very much so and it took a little bit of time to think this through. What we’re leveraging on the front ends are risk identifiers that are being used today by health insurers throughout the US. And so those could be as part of benefits as as an employee or as a member of a plan. Individuals may be participating in a biometric test on a voluntary basis, or a health risk assessments, or there may be some claims data analysis going on with the health insurer, or they could be using a CDC based risk screener. And what Newtopia is doing is we are leveraging those data sources that are in place today to help identify the roughly 80% of the population who’ve got elevated risks. But the most important part is, while it’s important for us to understand that individuals at risk, what we’re playing on is the timing, when that individual at risk understands both the risk factor but what it means and so the the notion that, oh, I’m heading toward a heart attack, or a stroke, or the development of type two diabetes, or a musculoskeletal injury, or maybe a serious mental health disorder, we want to play at that moment of concern with an opportunity to do something about it. And that’s generally where our engagement begins, and where our conversion begins, in either the employer or the plan setting. And then once we’ve converted that individual at risks to a new topia, participants are learning begins. And so we’re using a couple of tools to be able to draw out the social determinant backgrounds, the personality, motivation, readiness to change. And of course, we’re using just that simple saliva based genetic test to evaluate the genetic engagement portion. And so that really how was to inform that starting point. And and then, along the way, we’ve now built a very powerful engine, whereby each of our participants is matched to a member of our team called an integrator, those are really coaches with superpowers that utopia. And so between the ongoing communication with the integrator and participants, and all of the metadata that we’re collecting, through the interaction with our platform, we’re able to assess changes, and we’re able to make dynamic changes ourselves to the recommendations around habits to nutrition, exercise, and mental and emotional well being. So it’s a very dynamic process with inputs coming. But we’re constantly refreshing those inputs so that we can remain dynamically relevant to the individual. And it’s probably why we have some of the highest engagement rates in the industry, bar none, over what is sometimes five plus years of engagements on our platform.
Nick van Terheyden
So as you look back, you’ve obviously managed to tease out the elements of success. What what drives that engagement, I think, you know, amongst all of the things that you talk about, they’re all important, but actually getting people to act on information, to me feels like the sort of core foundation, what have you found to be the sort of key elements to effecting that change? Because you’ve obviously found a pathway to this? What’s it what have been the sort of learning points through that experience?
Jeff Ruby
I think, in many ways, it’s meeting an individual on their journey, when this is going to be meaningful to them is very important. So getting that timing, right, I’d say is a very big lesson learned. And also, a second lesson is doing it in partnership with an organization that really has the best interest of their employees or members at heart, where, you know, we’re not offered a hunting license, but we’re offered a partnership, where together the employer and nutopia, where the plan and Utopia are really, for the best interests of the individual. And of course, the economics of the health plan, or the employer, working together as partners, those I’d say, would probably be the two biggest learnings of what conditions for success look like. And then the last wouldn’t be once we have that insight, it’s tapping into that intrinsic motivation, right? It’s extreme zyk of rewards are important, but ultimately, tapping into someone’s why, and then building very incrementally, and ultimately making them the engine of their success. Always back to that intrinsic motivation. I would say that’s the the ultimate performance.
Nick van Terheyden
So clearly important, I think we can both agree, we’re going to see much, much more of this. I mean, there’s no question that the impact of this pandemic, both clinically, but also mentally, and, you know, all the sort of downstream effects are going to be huge. So tremendously important, what are you excited about? What’s what what is the future hold for you, as you look forward, and, you know, continue to sort of add to the platform and the capabilities?
Jeff Ruby
No, I, I’m, I’m both. I’m both terrified and excited by where we are in and around risk. And I think there’s an awareness that staying the current course, there’s, there’s only so much percentage of GDP, that we can keep investing here. And I’m seeing more and more innovators turn to looking for prevention and at risk. Whereas in the past, it was a nice to have, I think it’s becoming much more of a must have these days. And I’m excited about that. Shifting from the Newtopia standpoint, we’ve we’ve really just, we’re just about to stand up brand new engagement platform up, which is bringing the very best of engagement technology, communication, technology, nudge technology, you know, video and group dynamics together. And I think it’s going to really help take what we’re already doing to the very next level, both for the benefit of individuals for the health plan to our our partners and for Newtopia. So that those would be where I’m, I’m excited to most of that.
Nick van Terheyden
I like that I always try and end on the positive. But you know, I’m with you. There’s a little bit of terrified elements in all of this, but that’s what drives some of the change. I think it’s, you know, helped push us in the right direction. I think, you know, I have to be optimistic that whilst we’re going to see all of this, there are pathways and, you know, effecting this change and being able to not just answer your father’s question after the fact but to be able to have influence that so that maybe he never asked that question ultimately would be, you know, a prime sort of goal. Unfortunately, as we do each week, we’ve run out of time. So it just remains for me to thank you, Jeff, for joining me on the show. Thanks for joining me.
Jeff Ruby
Real pleasure to be here. Thank you for having me and hearing out our Newtopia concept
