What Do the Lochness Monster and Big Foot have to do with Smoking Cessation? with Dr. David Utley, President & CEO of Carrot Inc.
: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today's most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:19] Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring healthcare leaders. I really want to thank you for tuning in again and I invite you to go to outcomes rocket health slash reviews where you could rate and review our outstanding guests. Today we have an amazing guest. His name is Dr. David UtLey. He's the President and CEO at Carrot Inc. They're on a mission to engage and empower millions of people to quit smoking. But in a different way. And what we're going to dive into today is some of the basic concepts and things that they're doing at Carrot Inc that are going to make an impact in the way that this is done. And so my guest today has a wide array of experience and medicine. He started as as a surgeon and at Stanford University then founded his own company which was acquired by Covidien was the chief medical officer for quite some time. And now he's on to his next venture. And so what I want to do is open up the microphone to David to fill in any of the gaps in the introduction. David welcome to the podcast.
David Utley: [00:01:29] Thanks for inviting me excited to chat with you today.
Saul Marquez: [00:01:32] It is my pleasure David. And so one of the things that I like to do just to begin is ask the question why. What got you into medicine in particular why smoking.
David Utley: [00:01:42] Yeah this is my third career at Carrot. And as you mentioned my first career was as a surgeon. I trained an ear nose and throat surgery at Stanford out here starting in 92. I was there on faculty until about 2003 and I've always been interested in healthcare and healthcare related family wanted as a kid in the hospital. So I was pretty yes and I thought into sports medicine by ended up doing most of Europe and the Stanford our practice was a cancer practice and we almost exclusively focused on cancer related to tobacco use and they were related and they had that which is like your tonsils or your voicebox and it was pretty frustrating to me as a doc that there weren't a lot of things that we could do to help people quit smoking. And when we had pamphlets and we had warnings for the folks and we told people was bad for them. But you know I was in the treatment and I wasn't really on kind of the prevention. But I was thinking about it and you know like you mentioned before aside professionally I bet every one of the listeners has a friend or family member that's been touched by the use of tobacco. They've either got middle from it other kids are sick or maybe unfortunately they passed away they have a grandparent or something. So we all either professionally or familial lives like socially or touched by this gigantic awful product that people become addicted to. Typically when they're teenagers they smoke into their adulthood and about 80 percent of people who smoke don't want to be smokers but they don't have something that they can turn to. They can actually help them quit effectively.
Saul Marquez: [00:03:10] It's a really really amazing focus that you guys have talked about and you know we had a chance to connect before the podcast David I told you my dad you know smoker and he's tried different things and it just hasn't worked for him. I met your team at the Health 2.0 meeting and they they walk me through the approach. And so I love for the listeners to just get a better idea of why carrots different and how you guys approach a situation.
David Utley: [00:03:38] We started the company about it about two years ago and we decided that when you're looking at a behavior that 40 million U.S. adults participate in and 80 percent or more of them say when asked that they don't want to be a smoker but don't know how to quit that's a problem. But it's also an opportunity. Right. OK so if you think about the fact that you have this massive number of human beings engaging in mortal behavior and they reengage in that behavior 20 times a day when you smoke a pack of cigarettes you have to ask why and you look on one hand and you know that there's thousands and thousands of clinical papers and strategies around behavioral change and nicotine replacement therapy et cetera. Tons of strategies that work that when applied properly somebody actually uses them in some of these walking group. People can quit and they can durably quit. The problem is that smokers in general have very low confidence that they can quit and they have very low like a low access to really awesome quit interventions. You might want to actually try and not be scared of. So we thought right if the classic 1 800 QUIT number isn't helping millions of people quit. If over-the-counter drugs aren't helping millions people quit. If millions of people aren't flocking to the clinic on Wednesday night at their local YMCA how do we fix it. What do you do. And we want you to separate completely change the conversation. And you've got to present a program that people will at least try. And what I mean by that is program where they don't have to quit right away. So we offer you know you asked what's special about Pivot which is the product name Pivot's first session or first module out of 6. Over the course of a year is just nine days of meeting your coach doing some lessons monitoring your carbon monoxide in your bloodstream and also tracking your cigarette. So if we lower the bar and say you want to quit when you come here you just have to do some fun stuff with your coach and learn about yourself. We find like 90 percent of people would sign up for that. So the first step sounds really simple. Just get something that's attractive and fun and not threatening and that people don't think they'll instantly fail at and then they try it and then we try to move them into the next step. So let me when we take your question your inputs on your insight into that.
Saul Marquez: [00:06:00] No. Yeah. You know what. DAVID It's really fascinating. The approach right. You don't make them feel bad for being a smoker. You acknowledge that it's a true problem and you just level at them and say it's OK.
David Utley: [00:06:11] Right. Our coaches are trained in smoking cessation. We have a curriculum that everybody goes through and our coaches meet our tipsters we call them our users. We need the user where they are rather than say tell them where we think they ought to be and we help them build intrinsic motivation to guide helping them learn about themselves and gaining their own insights and supporting them because you know if you tell somebody to do something you're not going to get anywhere. These these folks that are picketers have been smokers for 20 years and they know it's bad for them. Their doctors have told him to quit they haven't quit successfully so they feel pretty bad about it. They don't want to feel bad again. So they said they don't like to sign up for these programs when they see a program where they can't fail. Then they get kind of excited that this is something new because as I said a minute ago most smokers don't want to be smokers.
Saul Marquez: [00:07:02] You know and I think the analogy of the fish in the little glass and the fact is the fish keep swimming around and if you tell that little fish to do a workout and eat well if that water's dirty that water is dirty. And so what you guys are creating is a different bowl for this fish to swim and it's a huge aquarium that you guys are building from my perspective. And these fish cannot swim freely in a new environment.
David Utley: [00:07:27] It's something new. And I mentioned we have some really interesting. I put on my public health prevention hat for a second. We're trying to prevent millions of people from dying and getting sick from tobacco. So the only way as I said to accomplish that is to start at the funnel and help as many people feel good about joining the program and not feel obligated not feel like they're going to fail. And one of those things is giving them lots of choices that they get. Like you just said lots of choices and lots of new things. We even have some I don't like the word campaign but we advertise within you know a payer or a client that would allow that would afford this to their employees. We advertise it to users and we have some campaigns that are very provocative like don't quit smoking today. And then in the subtext it's you know that's shocking for someone to see that but it's intentional because if he try to quit today and you haven't prepared the likelihood of failure is high and then just one more failure attempt. Right. And then one will less likely step towards quitting. We also have a cold turkey is a myth campaign where you know colds are going cold turkey is a myth just like you know the Loch Ness Monster is a myth it just isn't real. Like you can't just stop. Maybe there are some heroes that can just stop and never smoke again. But the majority of people really need a lot of help. So again the magic is getting folks in. But once they're in the program all of the coaching and all of the strategies are very much clinically proven in thousands and thousands of papers to help people learn about their smoking and then quit.
Saul Marquez: [00:08:59] Yeah they have it in and listeners I had a chance to take a look at some of these ads that Dave and his team put together. I mean this is a fresh approach and it's much needed in this space. And David I don't know if you'd be able to share those link on your show notes or not but I think it's just fascinating. So maybe we can. And so listeners will when I give you the link to this episode further down the bottom you'll be able to see those posts but just so you know ahead of time outcomesrocket.health/carrot. And if you go there you're going to find the show notes as well as the pictures of these really cool ads that he's creating a lot of creativity going into this making it different. So David one of the things that I find really interesting. So you've had previous success in building a company and you know sold it to Covidien. Now typically what's out there is that OK it's got to be B2B but here in this concept you have a B2B to C. Tell me a little bit about why you're deciding to go to something that is like a road less traveled.
David Utley: [00:09:59] Yeah. In my second career which was building a medical device intervention that would help people who would help us have surgeons treat early cancers of the digestive tract without having to do operations. That was a system that was sold to hospitals and surgeons like myself would use it to help save lives and prevent disease. That's a very different path than having an intervention where the user is not the surgeon the user as a smoker exhibitor. And then you need to pivot hers or folks that live in the United States who smoke have health care insurance and have it typically have an employer that provides some benefits to them. And smokers are users aren't used to paying for all of their own health care out of their pocket. So we want this to be paid for by a second party which is the person that owns most of the cost of that person's smoking and in our case it could be somebody could be a company like Medtronic for example that self insures all of its large employers or sales force or Apple or GM. Pick your large employer who self-insured. And what that means is they pay for the claims for health care that come in for their workforce. They don't pay insurance to cover those folks. So we've decided to go to that group first because smoking is not only a mortal behavior. It also is very bad for the bottom line of a company who employs smokers and that's not to be misconstrued as saying we shouldn't employ people who are smoke, you should. We should simply provide those workers with the best possible innovations and interventions to help them quit smoking. And the reason why are multiple you should help your employees quit smoking. Number one because it's the right thing to do. Just like making sure your employees have access to other amazing preventative services like colon or could be screening for mammography. You should offer a smoking cessation to everyone who smokes. Under the Affordable Care Act you should do it with no insurance and no casher. That's the first thing. The second reason is it's great for the workforce as a whole to improve the nonsmoking proportion of the population that's not by firing smokers that by making the world a better place and helping smokers quit. But the third one that really gets the clients attention is that smokers are extremely costly to an organization in dollars. They generate about 7000 dollars of excess healthcare expenditures and lost productivity every year per person. So as an employer if you use pivot and you help people quit smoking you can regain. You can recoup those losses and become much more it's a positive impact your PNL like within a year. So there's so many reasons to hope and employers workforce become smoke free. It's mindblowing. And so we're we're the newest and most innovative solutions that our employee clients have seen you know for some time.
Saul Marquez: [00:12:47] David I think you are tackling a problem head on and one that that is really fascinating. A couple of months ago I had the privilege of having a guest Dave chase. He does a lot of work in the employer benefits area and he wrote this really cool book you know restoring the American dream but the whole concept that he encapsulates in his ideas is that the costs for health care for employers is skyrocketing next to the cost of labor. It's the cost of just health for these companies right. And I think it's fascinating that you decided to take this approach because it is truly one that employers are starting to wake up and it's exciting to see that there are options through carrots and the things that you and your team have put together for them to tackle a problem and save money and help the lives of their employees while they're at it.
David Utley: [00:13:39] Yeah I agree. Thanks. I mean sometimes we have to remember that the employer is responsible for the health of its employees and their spouses. Medically and kind of in the wellness world and sometimes those overlap and if you understand that you should pay for a colonoscopy in somebody to detect polyps and prevent rectal cancer there is no return on investment for doing that. You just do it because that's what you do under a plan. And that's what the guidelines for rectal cancer prevention say the same holds true for smoking cessation. You gotta offer this and you should be like insistent that folks try it because it's like the right thing to do for the person's health and for the piano.
Saul Marquez: [00:14:19] Yeah I totally think it's a great insight that you're making and maybe some dots haven't been connected by some of the leaders listening to the podcast. So if you're a leader running a business unit running an entire company I encourage you to start thinking about the things that that David is mentioning here. You know smoking cessation programs are a must. And you've got to start considering these programs for your people. So David maybe you could share of a time when you had a setback or a failure and what you learned from that moment. It could be with carrot. It could be with another company that you've had. And what pearls have you taken out of that.
David Utley: [00:14:53] Well I think starting a company I've had lots of setbacks and failures. We all have right. And yes you don't learn from let me make the mistake twice then shame on you. Right. And so I'll just focus on more in the startup world is you know you were always building value in a startup. Every month every week every day and you're always telling the value story to clients to potential employees to investors and that's the thing I'd focus on literally every day along like what we want to continue to interact with investor interests continue to attract client interests continue to attract great employees here. I think we think one of the things along that line is that with self-insured employers who are benefit buyers they have a long path upon which to plan what services they offer to their employees because their plan a five year plan through your plan etc. and they have a relatively small budget. So I think one of the it's not an error or as much as just Meliton epiphany that offering wellness programs like pivot to employers takes time. And so we're budgeting now the time that it takes to properly get into the race. Clients like sales force and like some other big props that are going to they're going to work with us and make sure that we have enough time in the budget to make sure that those folks are successful because we have an incredibly solid foundational product. It's not about whether this product is to help people what it does it's just about whether we have time to get in the startup world through to all these folks that have a little bit of a slow sales cycle.
Saul Marquez: [00:16:25] It's a good call out right. Making sure you plan enough time to make sure that things move slow and health care period. And whether it be on the insurance side or the health provider side it's a big thing and it'll be interesting to see what trashing you guys could get to David with some of the big providers across the country because all of them are self indifferent to. Right.
David Utley: [00:16:44] Yes absolutely. We have a second plan. You know I'm very used to the way the interventions drugs services surgical procedures are considered by health plans like the blues and United Cigna and we will be talking to them starting this year because you know when you're a large land you own the health of your covered lives. I mean the healthier that cover like population is especially in captive plans like Kaiser the better your bottom line is. And so we're just relatively you know we're just going out of the box. You just got FDA clearance for our product last year about six months ago adults in addition to this. Yeah it was a great milestone. But in addition to getting there in addition to getting off the plate with some of these elements required we will start talking to the big national players.
Saul Marquez: [00:17:29] You know and it's interesting too one that I think would fit your model really well David you probably already thought about this as bright health. You know the folks over there in their population health approach I think is really much in-line with the strategies. And you know the history of those guys at the UnitedHealth I think they're pretty bad then. So I think there's something that could brew over there with you in them. OK David. Getting close to the end this has been a lot of fun. I really appreciate you taking the time out of your busy schedule to carve out with us. This is the part of the podcast where we do a lightning round for questions all about health care it better and then we'll finish up with the book that you recommend to the listeners as well as a podcast that you recommend to them.
David Utley: [00:18:11] Wow. Wow. All right. All right.
Saul Marquez: [00:18:15] What is the best way to improve health care outcomes.
David Utley: [00:18:18] Prevent prevent prevent before the person gets the disease taught all she says.
Saul Marquez: [00:18:26] Still love it. Love it. What is the biggest mistake or pitfall to avoid.
David Utley: [00:18:30] Well I wouldn't clarify the question about the meaning and public health in general and the health delivery of health care in general. Do you mean more like that to grant your level of Stardock or a health care focused company.
Saul Marquez: [00:18:43] You know I say let's it really it's kind of open ended but I'd say since we're focused on public health and making these changes to the smoking community let's answer it that way.
David Utley: [00:18:53] You know I think we focus so much on effectiveness and we haven't focused on reach. And what I mean by that is that everybody when you're talking about intervention how good it is like Does calling us could be in a 50 year old male prevent cancer. How good is your how good is the rate in our world they say. What's your quick rate. And what I way without being snarky I say we really don't care so much about the quit rate. We know we're going to get a certain percentage of folks to quit typically 20 to 30 percent. What we care about is how many people went through the program like how many people signed up. If you get one person that goes through the program because the program dry and you get a 10 percent quit rate. Well you know you don't have very many quitters if you get a million people to go through the quit program and if you have a 20 percent accuracy or 200000 quit or so I think you've got to move way upstream like I said with some of our campaigns where you get as many people to participate in the prevention as you can. Like every adult at age 50 get the colonoscopy and 100 percent of them do that's nirvana for public health whereas smoking. You know it's like some we talk to some clients were less than two tenths of one percent of the smokers are participating in the program because they're tired. So reach all about reaching out to get people in the program.
Saul Marquez: [00:20:05] Love that. David You do such a great job of simplifying things that are very complex. And this you know I'm going to definitely be doing some more thinking about this. And listeners I encourage you to think about this as well are you to be more concerned about effectiveness or reach in the things that you're doing. And so this is a really really interesting concept that you've introduced us to David. How would you say relevant stay relevant as an organization in health despite the constant change.
David Utley: [00:20:34] Yeah you know when I was brought up as a surgeon 26 years ago as an intern. We had nothing no nothing about outcomes and economics. We just were in the trenches. We did our procedures. We made sure people had the best possible care and the billing companies and all the people did that you know nowadays the economics are so involved in everything we do and when we're talking about you and our company I'm amazed that we're even talking about the economics of helping somebody quit smoking. It's just the right thing to do. I mean it's it's most impactful prevention services anything judged by the U.S. Preventative Services Task Force it's the Grade A. It's right up there with any other prevention that you can do because it works so well to help people not die. I'm surprised money ever even comes up because it's pretty cost effective very cost effective to provide smoking cessation services to folks so I think that's the biggest surprise. I'm surprised that economics are even being asked about any part of that is because smoking isn't lumped into the wellness benefits thing called nostri screening not in wellness benefits within limits in health care benefits without it wellness. So we're going to try to make sure that folks understand that smoke is their number one cost in health care. Remember recrossed and wellness they should provide as many resources to help people quit and rethink just as I said earlier rethink how this whole disease state is approaching.
Saul Marquez: [00:21:53] Outstanding. And another great point that you just just keep bringing a man named after the other and I love it value pack session listeners and if you're on the benefits side of things are you considering smoking cessation part of wellness benefits or are you considering a part of health think that think that through. Finally David what's the one area of focus that should drive everything else in your organization.
David Utley: [00:22:19] Our mission statement is to save lives. And you see that written on walls and then on websites of people you know in tobacco use. It's true. We have a very mission driven company and everybody every one of my 55 employee team members believe you know I ask every raise their hand if they've ever saved a life. If had they not been there or created something would someone have died. It's rare unless you're a doctor remaster or some sort of some profession like a firefighter or you don't typically raise your hand right. But everybody here raises their hand because we've got people quit my crazy and my engineers and my clinical guys and my coaches and my CFO and me everybody can say you know I was part of that and if we let this war long enough we get to a million new users a year in the next six seven eight years. We're to save millions of lives. So that's raise on debt. Everybody's completely focused on that as their mission because it's true.
Saul Marquez: [00:23:16] No doubt about it David in when I when I met your team at the Health 2.0 meeting it was really inspiring. I mean I had the opportunity to meet. It was Conney. And I also met Blanken Ray little John John and I get older. Yeah I met Connie and John and boy let me tell you I mean they were just filled with the passion that you have. So as as a leader. David I want to commend you for what you've done with this team and the people you've brought on. They are just magnificent people. David here to the end. What book and what podcasts would you recommend to the listeners.
David Utley: [00:23:54] My favorite authors Christopher Moore and o are the funniest guy you will ever read. Practical demon keeping is my favorite book of his and he was my favorite podcast.
Saul Marquez: [00:24:05] Outstanding. So listeners make sure to go to outcomesrocket.health/carrot where you're going to get all the links to what we've talked about today including the show notes. So thankful for your time. David why don't you just share parting words of wisdom. And then the best place where people could follow you.
David Utley: [00:24:24] Well I think the parting was over after having this discussion is that smoking in the U.S. has been kind of lateralized and people kind of forget. I mean we make people smoke outside. We make people don't let them smoke in have vilified the person and the behavior. And I want everybody to maybe part this call with the fact that people who smoke mostly don't want to smoke and they're mostly awesome people and they need a helping hand and they need some awesome innovation that can help them with this disease or this behavior which causes death and over half of folks who smoke and we think we hope we are in crisis is huge. Smoking kills ten times more people every year then the opioid crisis ought to be receiving at least equal if not more investment and focus as these other global and slash U.S. health care crises.
Saul Marquez: [00:25:12] Great note to leave off with David and what would you say the best place for the listeners to follow you or get ahold of you is.
David Utley: [00:25:18] You know carrot.co they can look at LinkedIn for carrot, carrot inc. Those are probably the best places and I think also on Twitter even telecare into that.
Saul Marquez: [00:25:28] Beautiful. David this has been amazing. Truly a paradigm shift discussion today listeners hope you enjoy today. And again David just a big thank you to you and your time my friend.
David Utley: [00:25:40] Hey thanks, Saul. Have a great day. Bye bye.
: [00:25:45] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.
The Best Way To Contact Dr. David:
Twitter - @CarrotSense