Rachel Munsie, Head of Business Development at Tomorrow Health

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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez is here, and today I have the privilege of hosting Rachel Munsie. She is on the founding team of Tomorrow Health, a technology-driven home health care company changing the way individuals and families manage their care. She leads business development, focusing on partnerships and sales, strategic marketing initiatives and new market expansion. She was formerly in health care investing. She’s working to unpack the US health care system and understand how we can treat better incentives through innovation, policy and advocacy. Rachel received her bachelor’s degree from Georgetown University and attended MIT for her MBA before leaving to build Tomorrow Health. The DME durable medical equipment field definitely is a need for innovation, and the work that Rachel and the team at Tomorrow Health are doing is super unique. And I’m excited to be covering that with you, Rachel, today. And so I want to give you a warm welcome. Thanks for joining us.

Rachel Munsie:
Thank you so much, Saul. Really appreciate it. And thanks for having me.

Saul Marquez:
Absolutely. So before we dive into Tomorrow health and what makes you guys so unique and different in that space? I’d love to hear more about you, Rachel, and what inspires your work in health care.

Rachel Munsie:
Absolutely. So I am most inspired about solving the problems of health care and really the ones that we’ve all faced. So we spend more on health care in the US than any other country in the world. But our outcomes are worse and everyone understands what this means on some level. I personally once racked up a bill equal to my entire rent payment during one doctor’s appointment, because even though I knew I had a high deductible plan and even though I knew I’d hardly spent anything against it, I mean, I work in health care. I threw out all of my practical knowledge just because I was anxious and nervous and in a vulnerable situation. And I think when you’re sitting in a doctor’s office or hospital, you rarely compare prices or shop smartly. And most people don’t even know that you can do that. So most of the time we do things because we’re scared or we think, what choice do I really have? My health is at stake. And I think sometimes the prices in our system take advantage of that. So it took me a while to internalize. And I think, well, most people don’t realize is that we all pay the price for our broken health care system, whether we know it or not.

Rachel Munsie:
So either through lower take home wages or higher premiums or higher deductibles or even higher taxes. And I actually still have those outrageous bills sitting on my kitchen table as a reminder to myself that these costs aren’t normal and I think we deserve better. And so since digging into this industry first as an investor and now as an operator, I’m just constantly floored by the unnecessary complexity that I found in every corner of the ecosystem. And no one understands any of it. I think people inside the industry barely do. And it’s the result of some wacky incentives that have run amok and not always the best intentions. But this is exactly how that knowledge gap between industry stakeholders and patients and the broader general public just becomes so massive. And so when it came to my decision to help found Tomorrow Health, it’s not an exhaustive solution, but one clear trend with positive impact on all of these stakeholders is the shifting of more care to the home, which is higher quality and as we know, a much lower cost of care setting.

Saul Marquez:
Yeah, you call out a lot of issues that we’re faced with. And I think every one of us you’re listening to this podcast today, you’re thinking I’ve been screwed with a big medical bill or if you haven’t, which I’m sure you have, if the very small chance that you haven’t, I’m sure somebody in your family or a close friend has dealt with it. And I think it’s great that you keep that bill on your kitchen counter. Rachel, just to as a reminder, Right. of the why behind why we’re doing what we do. Care in the home is becoming that much more important with COVID among us. And so reimagining that health care is critical, as you guys like to call it. So talk to us about the work at Tomorrow Health and what exactly you guys are doing to add value to the health care ecosystem.

Rachel Munsie:
Yeah. So at Tomorrow Health, we are a technology driven home health care company and we are a full stock provider of health care. And we’re a trusted partner that you can depend on to coordinate and deliver specifically home medical equipment, supplies and support, all in the comfort of your own home, which, as you mentioned Saul in COVID world is extremely important. And our big focus and vision is on restoring the home as the focal point for health care delivery and the genesis of Tomorrow Health was personal for us. Our co-founder and CEO Vijay Katar was working at Oscar, so he was well versed in the complexity of health care. And his mom was diagnosed with stage three cancer and she needed about a year of intensive home health care. Luckily, she’s now doing much better. But he was responsible for coordinating so much of that and he and his family had to work with over a dozen different providers who are coming in and out of her home to get what she needed. And after about a month when she was discharged from the hospital, she ended up having to go back three times in her first month home because of delays or equipment failures relating to her oxygen therapy. And so for patients and also their families who are usually playing the role of caregivers, it just shouldn’t be this hard. And then from a systems perspective, why else does the home matter? And by dramatically reducing our dependence on hospitals, on ERs., on post care sites, we’re able to get high quality care at home and also bend the cost curve in the health care system. So by working with Tomorrow Health, we think it makes it easier to shift that care to the home because one of the legs of the stool for home based health care are these home medical equipment, supplies and support.

Saul Marquez:
Yeah, that’s very interesting that you guys decided to integrate that into how you’re providing care. So talk to us about what makes you guys different and potentially even better than what’s available today.

Rachel Munsie:
Yeah, absolutely. And first, remember what we’re used to today. So I always think about it as I’m used to pushing a button on my phone and having a car show up on the corner of whatever block I’m standing on. Or I receive minute by minute email updates with all of my e-commerce packages. And I can also compare prices of different products I’m buying from my couch. So I’m used to this very consumer friendly world. And then you step into the world of health care, you feel like you go back in time a little bit. So imagine you have a 60 year old man, I’ll call him Larry, living in New York City, working as a security officer for a big corporate building. And he spent 40 years on his feet in this job. He commutes over an hour by bus or subway each way. He walks up and down flights of stairs for decades. And so he starts feeling pain in his knees and his doctor diagnoses him with osteoarthritis. And this can’t be cured. And it’s just a pain that gradually worsens over time and can become excruciating. So his doctor prescribes him a walker to take some pressure off of his knees.

Rachel Munsie:
It’s a mobility aid that can help him continue to work and get around. And the good news is that Larry’s insurance covers these items, medical equipment and supplies. And given that, Larry, maybe he has children he supports and his own expenses, he would like to use this insurance coverage to get what he needs. So Larry would start calling medical equipment stores in his area. And because going to each of these in person would mean he would have to take a bus to get to them. And he doesn’t have the time. He calls them, let’s say he calls eight of them. Four would pick up the phone for go to voicemail, maybe two, don’t take Larry’s insurance. And then one says they don’t even know if they have what he needs in stock in their store. So he’s really left with one. And they tell him in order to have this walker covered by insurance, he needs to have his doctor or himself fax his prescriptions and mountains of forms to them, which is, I don’t know, who owns a fax machine in these days.

Saul Marquez:
Poor Larry.

Rachel Munsie:
And so Larry doesn’t have time to get back in touch with his doctor’s office, as most of us don’t, and might have to wait until tomorrow or the day after.

And when he finally reaches them, he can initiate this fax transfer and then he has to call the supply store back to make sure they have got the forms and ask when he can come pick up the walker. But if the store is only open while he’s at work or at his job, he needs to wait until maybe he has a day off to go make the trip to pick it up. But in the meantime, Larry is working through this pain, maybe board his bus first in the morning because people don’t see that he has debilitating pain in his knees. But of course, if he had a walker, this would be easier for him to demonstrate to everyone around him. And he could go up and down the stairs at the subway platforms with more help. And so, by contrast, we at Tomorrow Health change this entire end to end experience for Larry. And he can very easily order online or by phone. He gives us three pieces of information and our online catalog can actually update to show accurate cost estimates based on his unique individual insurance coverage, how much he might owe for the walker. And so we also have free home delivery within two days. And we have a team of care advocates who I wish that my own mom had had when she went through it, recovered from hip surgery a year ago because the experience and the service they provide is is really unparalleled. And since we’re entirely remote, Larry, obviously never has to leave his home to get help. And we do the work of dealing with insurance and doctor’s offices. So really, we’re using technology, plus this amazing experience from our care advocates team to fundamentally change that entire experience for someone like Larry.

Saul Marquez:
I think that’s awesome, Rachel, and it shouldn’t be as complicated as it is and it’s unreliable. And why should Larry deal with this? Why should any of us deal with this?

Rachel Munsie:
Absolutely.

Saul Marquez:
So tell me a little bit more about why this area and who benefits from the higher degree of efficiency here, talk to us about that.

Rachel Munsie:
Absolutely.

Saul Marquez:
Obviously, Larry Right., but.

Rachel Munsie:
Obviously, Larry,

Saul Marquez:
And so from a B2B standpoint, like health care, a lot of things, the incentives, the economics, like shed some light on that.

Rachel Munsie:
Absolutely. I mean, think about it. In the best case, Larry’s care might be delayed a few days or a few weeks. And in the event that he was actually trying to be discharged from a facility, those delays in that back and forth of faxing would actually cost the system at large inpatient costs if Larry were to stay in the hospital and be delayed on his discharge. And we’ve seen stats that 90 percent of care managers report delays in trying to discharge patients due to these types of medical equipment and supplies and efficiencies. So it’s definitely a real pain point that’s felt. And that’s almost in the best case, because in the worst case, Larry actually gives up. So this is such a hassle or it’s so frustrating that he maybe decides to tough it out and not paying attention to chronic pain in your knees, for example, could worsen that condition over time. It could lead him to fall one of the days at work or going upstairs. It could wind up in urgent care or an E.R. And that’s crazy and it just shouldn’t happen. And so we see home based care providers like us as critical to improving outcomes by reducing discharge delays or readmissions from the home, but also while empowering patients like Larry with visibility and customer service that you would expect in every part of our lives today.

Saul Marquez:
Awesome. I love that. And so there’s an opportunity from a consumer standpoint, but also from a care management standpoint to leverage the platform.

Rachel Munsie:
Absolutely.

Saul Marquez:
Very cool. Very cool. I mean, I think it’s so great. And so give us a story like take us to something real that’s happened. And I love the Larry example. You’ve made it very real. But give us an example of how you’ve improved outcomes or business with what you do.

Rachel Munsie:
Yeah, absolutely. So we actually have this expression in our minds due to COVID. We’ve actually treated patients who who have been infected with COVID and in some cases, if needed, respiratory therapy while at home and also mobility aids while they’re kind of returning to their normal level of strength. And so in this case, without Tomorrow Health, a lot of these patients were using up facilities and beds and hospitals are unable to be discharged on time because they needed to be able to continue receiving some form of their care, kind of stepping down in their care plan in order to return home. And that was something in our where we’re headquartered in New York City, we saw firsthand. And so from a business efficiency perspective with our health system partners or of course, with the health plan partners that we work with, everybody was incentivized. And in this moment, obviously both because we’re empathetic to the difficulties going on during COVID, but also from a business perspective to make sure that we reduce the strain on our hospital systems at a time like this by making sure people could receive their care at the same level of quality they could in a hospital setting at home.

Saul Marquez:
Fascinating. So you guys have clinicians working for the company?

Rachel Munsie:
Yeah. So our care advocates team have clinical knowledge and are clinically trained, not all of them, but some of them. So we do have clinical expertise injected into everything that we do. We also have clinicians review the product descriptions on all of our catalogs so that we’re actually thinking about what product would work best for what condition or what type of patient. We think that’s actually an important distinction, that it’s not always a one size fits all.

Saul Marquez:
I love it. Yeah. And I mean, it’s very real right.. And one of the biggest concerns with COVID is that the bandwidth just overwhelming the system and having an option like you guys to provide respiratory or or even if it’s like musculoskeletal care through devices, it’s important to free up those beds. And so question for you, Rachel, what would you say is one of the biggest setbacks you’ve experienced and what’s been a key learning from that?

Rachel Munsie:
Yeah, and I was thinking about that, that we’re talking about COVID. I think one of the challenges that’s freshest in my mind is the experience of facing COVID as a newer health care company and actually having our company’s public launch in the middle of COVID. So we were already operational in March, but we had planned to do a broader public launch this summer. And so we had roadmaps and new features. We had a date circled on the calendar and all of that just went out the window in early March when COVID changed the entire health care landscape, but also society as we know it. And the timeline that was three months long went to two weeks. And we just knew that our capabilities were uniquely suited to help people in this time, but required working through that period, day and night meeting with New York City government stakeholders and agencies to understand how can we serve more vulnerable populations, these are people, especially seniors, who would be homebound and potentially isolated, needing equipment or support or medications or food delivery. And we were just asking ourselves, how can we help reach them? It was a very, I think for everybody challenging and anxiety inducing time. But a key learning is really how effective it is to marshal a team around a common mission. And I think in this case, we all just felt a lot of conviction that if we moved up our plans launch publicly in a crazy timeline that I would not have I would have laughed at if I had seen it months before we could reach for this.

Saul Marquez:
I’m not signing up for this.

Rachel Munsie:
Everyone was like, OK, this defies the laws of physics, but we will do it. And I think that was the most important part, was just understanding in those times of need people really they find a way to step up. And so we had to do just that. But I think that was it was a challenging but extremely productive time for us as as a company.

Saul Marquez:
That’s amazing. Thank you for sharing that, Rachel. And you think about how the pandemic has either really slowed down or scaled up and sped up efforts. You guys are an example of how we fit into this. We need to speed this up. And kudos to you and and the leadership team there for seeing that and acting on it, because you could be really firm in your timelines and keep your head down. But you got to look up and around to make the right calls. And you guys did.

Rachel Munsie:
Absolutely. It helps to have an incredible team working with you to make that things like that happen for sure.

Saul Marquez:
So what are you most excited about today?

Rachel Munsie:
Today, I am most excited about the impact that we can make on the lives of our patients and our partners. We served a patient recently who was so thrilled with her new walker that she got from us and the service that she received that she actually called to tell us she had named her walker Louis,

Saul Marquez:
What did she name it?

Rachel Munsie:
Louie. And she likes to tell him no. So sorry, I can’t take you for a walk today because it’s raining outside or how jealous all of her friends are that she has Louis to help her get around and take walks in her neighborhood in style. And so I just love that. And it’s amazing what a simple walking aid could mean for someone who would otherwise no longer get around at the speed or efficiency that a younger person can. And it’s just so easy to underestimate what it means for people that we work with something that seems pretty simple, like a walker. And so I just really like the reminder of Louie the Walker when I go into certain days. And it it definitely gets me excited to make sure that we have the right impact on people’s lives.

Saul Marquez:
Well, I think that’s a great start, Rachel. And you think about the possibility of delighting a consumer in health care. I mean, and when you’re talking about durable medical equipment, you’re like, what? How do you delight somebody? And you guys are doing that, so.

Rachel Munsie:
Exactly. Exactly. That’s awesome. Customer delight. It’s a it’s a core tenet of ours. Is it. Yeah, it I think it’s so great.

Saul Marquez:
And so, folks, we have to be challenging the ideas that are in our heads. And Rachel has provided a great example of something that maybe we didn’t think was possible. Right. durable medical equipment being a delight to a customer. You’ve got to stop and think about how you can pair operational excellence with customer satisfaction. That’s better than than ever before. And so big kudos to the tomorrow health team and Rachel, tomorrow, health dotcom is where you could find them. But before we conclude here, Rachel, I’d love if you could just give us a closing thought and then the best place for the listeners to get in touch with you or the team to learn more about what you guys are up to.

Rachel Munsie:
Absolutely. So my closing thought is when it comes to health care, build a mission, not a company. And so I think that if you do that, it will ultimately benefit patients and will also benefit our entire system. And you can get in touch with me and the team at Rachel at Tomorrow Health dot com.

Saul Marquez:
Love it. Rachel, thank you so much. It’s been a great chat, really. Thank you. And congratulate you guys for what you’re building and doing there.

Rachel Munsie:
Thank you so much, Saul. Really appreciate it.

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