460: Frontrow Health with Irfan Alam

Irfan Alam is the CEO of Frontrow Health, a startup with a mission to finally put Americans in the front row of their own healthcare.

Will and Victoria talk to Irfan about his background in business strategy and development for healthcare companies, how he went about searching for and building the perfect team, and how he started the culture of Frontrow Health on a level where there is balance and people want to join because it has a good culture.

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Transcript:

WILL: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Will Larry.

VICTORIA: And I'm your other host, Victoria Guido. And with us today is Irfan Alam, Founder, and CEO at Frontrow Health, a startup with a mission to finally put Americans in the front row of their own healthcare.

WILL: Hi, Irfan. Thank you for joining us.

IRFAN: Thanks for having me; super excited to chat more about the whole process of building and launching Frontrow Health.

VICTORIA: Yes, we're super excited. Of course, I know you as a client of thoughtbot, and I'm excited to hear your story. And you have this background in business strategy and development for healthcare companies. But what led you to decide to start your own platform?

IRFAN: I think it was a combination of two things; one was a lived experience being inspired by the power of entrepreneurship with my family and then working at Everlywell. And then two, it was discovering and being reminded of a critical problem that I saw in the industry that I then became excited about solving.

So growing up, I was raised by my two parents and my grandparents. My grandfather was an entrepreneur himself and also an immigrant and kind of brought our whole legacy of my family into the U.S. from Southeast Asia. He has always motivated me to take risks and to build something great for the world, and that's what he's always wanted for me.

And so I joined Everlywell, a small digital health startup, back in 2019 because I was excited to get my feet wet in the world of startups. It was just within a number of months after that I had joined where COVID-19 hit, and Everlywell, a home lab testing company based out of Austin, got swept up into the storm of COVID and, in a lot of ways, threw ourselves into the center of the storm when we ended up launching the first home COVID-19 test.

And it was that summer of 2020 when I probably had the most profound personal and professional growing experience of my life, just trying to handle this chaos and confusing world that we were all living in. But then also simultaneously watching how a small team could make an outsized impact in the world during a time of need. And that really led me to want to pursue my own startup ambitions.

So I started thinking about business school. The founder and CEO, Julia Cheek, went to Harvard Business School in 2009 and publicly talks about it being sort of this magical moment in time where people were flooding in from the downturn economy, excited about solving new problems. And her class of graduates is sort of like a famous class of entrepreneurs. And so I brought it up with her, and she was super supportive. And I went through the process and got super lucky. And I decided to take the summer off in 2021 before coming to HBS and moving back to Boston.

And it was during that summer where I started thinking about the problems that companies like Everlywell and direct-to-consumer health brands faced that I realized was not just at the fault of their own but because the industry didn't have the right digital tools necessary to succeed. That's sort of the origin of how Frontrow Health came to be.

WILL: Sweet. So perfect segue; tell us more about the mission of Frontrow Health.

IRFAN: We're on a mission to put people on the front row of their own healthcare. And we really just want to reimagine how people shop for their healthcare online. What I learned at Everlywell was that this boom of consumer health which means people who are taking charge of their own health and are able to do that directly through these digital health companies was a form of healthcare that could create a tremendous amount of value in people's lives. But that was only really accessible to a small niche audience. And it didn't feel like it was equitably accessible to the average American.

And so some of those barriers that I realized as a part of my work at Everlywell for why the average American wasn't engaging with consumer health, this otherwise really powerful form of taking charge of your own health and wellness, was because of these three blockers that we're trying to address at Frontrow Health. The first being that people just don't know about what kinds of solutions are out there that can address their health issues beyond just taking a prescription medication given to them by the doctor that they visit in their office.

The second is if they do know, they don't know what to trust. They don't know whether this spam of healthcare companies that they're getting advertisements on from Instagram are the right companies, whether these products are safe and effective for them uniquely because of their unique health issues their unique health history.

And then finally, even if they are aware and they do trust the health product, at the end of the day, a lot of Americans just can't afford to spend money out of pocket to pay for these consumer health and wellness products like consumables, devices, virtual services, et cetera. And so Frontrow Health is all about trying to break down those barriers in order to unleash consumer health to the average American.

VICTORIA: And were you always drawn to that healthcare industry from the beginning?

IRFAN: Yeah. So I grew up very privileged with two parents who are physicians. My mom is a psychiatrist, which is quite rare for women of color, specifically of South Asian descent, to be a psychiatrist. And then my dad was a gastroenterologist. They were always the gut-brain connection between the two. And so, growing up, I somewhat classically assumed that I was going to be a doctor. Got to college, thought that that was going to be my path. I realized quickly that there is a whole world outside of being a physician yourself that I could still be a part of in healthcare without being a doctor.

My parents actually, interestingly enough, began to encourage me to think beyond just being a doctor, with them both feeling like the amount of scale of impact that they could have would never be the same as someone who could do that through business or policy or these other facets that are important to healthcare. And so I got to undergrad, started studying policy economics. I started doing internships at different healthcare consulting firms.

And I ended up first working at a life science business strategy consulting firm out of college. And it was great, but it ended up not being what I was most excited about because it was really focused on the biopharmaceutical and medical device industry. And what I realized when I got there was I just had this growing passion for digital health and technology, as I saw that it was kind of the future of how people were going to be able to take more preventative charge and improve their health over the long term.

And so I was working on this digital health white paper with a partner at the consulting firm I was at, and I was doing research and stumbled upon Everlywell. And then, they had a job opening for this business strategy role. So that's why I ended up taking the leap into the startup world, into the digital health world, and just loved it and kept wanting to continue to grow my experience in that space.

WILL: That's amazing. Your parents encouraged you to step outside of just the doctor-physician role and to think higher. So, as a founder, you know, it was amazing that your parents, as physicians, encouraged you to think higher and think into different roles. And as a founder, what were some of the decisions you had to make? What were some of the easier ones? What were some that were surprisingly difficult?

IRFAN: I think the biggest misnomer of the founding experience is that founding a company is extremely linear. Sometimes you go one direction forward, and then you take a direction diagonally back, and then you go horizontally straight, and that was my story. When I do my pitch about Frontrow, I try to make it feel a little bit more linear, so it makes sense to people.

But the truth is the quote, unquote, "hardest decisions" were about every time there was a direction changing point, and it required a decision about is this the right idea? Do I want to spend more time on another idea? Have I validated this enough? Should I validate it differently? Should I pursue this one further? What does that pursuit look like? Who should I pursue it with? Is it time to raise money? Do I drop out of school? Like, those direction-changing points that then create this much more complex map of the founder experience versus a linear line up into the right is, I think, the more challenging parts of being a founder.

VICTORIA: That makes a lot of sense that you have to really go through this iterative process to figure out where are you spending your time, is it in the right place? A lot of hard decisions to make. And while you were founding Frontrow Health, you were also a part-time investor at Rock Health and reviewing other healthcare startup proposals. So did you see any trends or patterns that influenced how you progressed as a founder?

IRFAN: Totally, yeah. That was actually instrumental to Frontrow Health. So the story is when I took the summer off before business school, I started thinking about different problems in the world, healthcare, and non-healthcare. Or actually, to be clear, I started thinking about lots of different solutions and ideas and then quickly began to realize that that was not the right approach to founding. I think the first step is to think about problems, problems you've seen, problems you've experienced, that you know others are experiencing, and then work to a solution from there by starting with what the user is experiencing.

And so as I was going through that hacky journey over the summer, just randomly, a number of small healthcare companies started reaching out to me asking me for my opinion and advice about how or whether they should go direct-to-consumer, whether they should sell healthcare products direct to the consumer, which is what I did a lot of work on at Everlywell as one of the pioneering consumer health brands in the space.

And I started to notice this trend of me telling these companies, "No, don't do it. It's really expensive. It's really ineffective and unprofitable to acquire customers through traditional paid media avenues like Instagram, TikTok, Snapchat, Facebook, et cetera." And, unsurprisingly, you could imagine Everlywell was trying to sell a home diabetes test for people who are type 2 diabetics but were only able to target people based on their interest in yoga and running, which is not really a substitute for a severe chronic condition.

And as a result, thousands of people would see our ads every day that had no clinical relevance to our solution. And that was one of the deep problems of why consumer health companies weren't able to reach out to the audiences that actually really needed their solutions. And so when I got to Rock Health at the first semester in business school, doing this sort of part-time investor gig, on the first day, the partners basically told me, "Oh, we don't invest in consumer health."

And I was like, "Oh, whoa, okay, that's my jam. That's a bummer. That's like [laughs] the only thing that I know about." And as I started to see the data and the pipeline of companies that were looking for investments and understanding what their unit economics looked like, what their go-to-market approaches looked like, that's when I started to put the dots together that this was not just an Everlywell problem; this was an industry problem. Mark Zuckerberg didn't build Facebook so that direct-to-consumer healthcare companies can cost-effectively target clinically relevant patients online. That just happens to be what it's being used for today. And so that's when I started to realize that there had to be a quote-unquote, "better way."

WILL: You bring up social media at Frontrow Health. Have you had to combat the medical advice of social media?

IRFAN: Yeah. You mean like this concept of quote, unquote, "Instagram medicine?"

WILL: Yes. Yes.

IRFAN: It's a great question. So as the story continues, I began to think about what is the right solution to this problem? And instead of Everlywell, I started thinking about the right solution to this problem. What I realized was instead of Everlywell wasting away millions of dollars to big tech companies that wasn't going to improving the health of anybody, what if we gave that money back to the consumer in reward for sharing their health information which would allow us to target them with the right clinically relevant products?

That was the first version of Frontrow Health. I called it Health Mart back then. And so I basically started to get people to fill out a Google Form with their health data. And then I worked with my parents to send weekly product recommendations over email based on their unique health needs; you know, I want to sleep better; I'm a diabetic, whatever it is.

And then, I wanted to see if I was just going to Venmo them cashback upon purchase if they were going to be any more likely to buy these products for these health brands. And at first, people were incrementally more likely to buy. It wasn't mind-blowing. And so, as I started to talk to the participants of the study, I started saying, "You know, you said that you have high cholesterol. These supplements have active ingredients that have been shown to reduce LDL levels. It's pretty cheap. I'm giving you 25-30% cashback. Why haven't you bought it?"

And what they started saying was, "Well, I don't know what these active ingredients are. And before I put that in my body, I want to check with my doctor first." And so that was the final aha moment that led us to Frontrow Health, which is, what if we could bring the doctor into the fold? And instead of consumers just experiencing this Instagram medicine where they're just being blasted with Instagram ads every day about different health products, and they don't know what to trust, that second barrier that I talked about earlier, what if the doctor could instead of just being a guide for what prescription medications you should be taking could also be a guide on what health and wellness products you can be using?

And so I added my dad to the email thread, and I said, "Okay, you can talk to an independent medical provider and ask them questions about the products that you're being recommended." And that's when people started buying because then they were able to find the trust in the products that were being curated based on their unique information.

WILL: Wow, that's really neat. So to help the audience understand your iteration today, so the first iteration was just giving products and then Venmoing them back cashback. And then the second was bringing in a provider. So what does the product look like today?

IRFAN: We went through, like you mentioned, a lot of different iterations of this. There were even prior iterations to this that are more representative of that founder map versus the linear line that you've sort of just heard now. But in terms of where the story went from there, I began to think about how to validate this idea further. I came into winter break; the pilot went well. People were buying a lot of products.

And so, I decided to sunset my part-time investor gig at Rock Health and decided to reallocate all my time to working on Health Mart at the time. What I started to think about was, well, what if the doctor was able to earn compensation for writing private product reviews regardless of their opinions? So that was the next iteration was like, how do you incentivize a doctor to take time out of their day to do this new behavior that doesn't exist?

Doctors are not writing personalized private product reviews for their patients on supplements, home medical devices, apps, et cetera. And how could we get them to? And so, I started thinking about what are the different motivations of providers? Their time is extremely valuable. How do you incentivize them correctly without incentivizing them to give good or bad feedback but just honest feedback?

Then I started basically having my dad recommend Health Mart to his patients every day to see would patients sign up. Like, if doctors were intrinsically motivated to get their patients on the platform so that they can help them get away from Instagram medicine and at the same time earn compensation for themselves as an additional revenue stream, could independent medical providers see that as valuable and a good use of their time?

And the first piece of that about whether patients would sign up worked unsurprisingly very well. If your doctor is telling you to sign up for something, or it's free to sign up, and you only pay when you want to buy a product, and they're going to, for the user, be able to ask for feedback from the provider, they were pretty excited.

But then the question of would doctors sign up, I started...basically, I had my mom. The next iteration was I had my mom make a couple of posts in these doctor Facebook groups. I put together a little website, a very ugly version of what we have today for a provider marketing page. And I had my mom drop the link in a couple of different doctor Facebook groups. And we actually started getting signups from the doctors.

And then, as we started talking to them, what we realized was two things; it was like a win-win. The doctor was happy because they were getting compensated, and they were happy because their patients' health was improving. So when Obama was in administration, he passed a really fundamentally important piece of legislation called The Sunshine Act. And that basically ended this quote, unquote, "golden era" of pharma companies giving kickbacks to doctors.

WILL: Oh wow.

IRFAN: And so since then, doctors have been very eager to find additional revenue streams that they can leverage their decades of medical expertise to earn. They got medical bills to pay off loans to pay off. They spent 20 years training for this job. And so they were excited about an additional revenue stream that leveraged their medical expertise and also helped their patient. Because they also started saying things like, "Well, my patients are always asking me like, 'What about these supplements I saw for these ads online?'" And the doctor says, "I don't know what these supplements are.

WILL: [laughs]

IRFAN: I don't have the data in front of me. I don't know what the ingredients are. I don't know whether to trust the company or not." And we are building a platform where it's all streamlined for the provider. The provider is able to review the clinical information. They're able to review their patient information. They're able to really quickly write reviews. We give them templates. We give them suggestions. They're able to reapply recent reviews. And so that was sort of the next iteration. And that's actually when thoughtbot came in and when I started thinking about raising a small round, getting a dev shop to help me build the MVP. And that's kind of how the semester ended up closing out.

VICTORIA: I love that your mom and dad were so supportive, it sounds like, of you going full-time on this startup. Was that scary for them for you to do that?

IRFAN: It's so funny, yeah. So what happened next was I decided I wanted to start raising a small round because I had the conviction that there was a problem to be solved for consumers, for doctors, and for health brands. And we could build this one unique multi-sided marketplace to solve them. I ended up going back to Austin for spring break partially to visit my family and partially because I wanted to pitch to Julia, the founder of Everlywell, who I thought of all people on planet Earth would understand what I'm trying to do. She would get it because I am building a SaaS solution for health brands like Everlywell and her consumers.

And she got it. She was jazzed. And so, she decided to angel invest. And that basically spurred a ton of interest from venture capital firms. I wasn't originally thinking about raising an institutional round but was very lucky with the timing. Just before the market crashed, it was a very hot market. And so we ended up closing a real seed round with the question on hand about whether I should pursue this full-time because the capital that I raised necessitated building a real team. Or should I just take a smaller amount of money and go back to school?

And it's unsurprisingly, every different person in my life had some opinion about this, from my wife to my investors, to my parents, to my friends. What I wanted was somewhere nestled in between all of those things. And when I caught my dad up on the phone a couple of weeks after spring break and told him of all the crazy stuff that had been happening...and it was just happening and unfolding so quickly. I was like, "Okay, dad. I'm laying out all my cards here. You have full liberty to be mad at me for wanting to drop out of Harvard."

And his first reaction was, "Well, you know, I don't really see the downside. Like, you could either start a company that you're really passionate about and it could go well, or you could be the worst entrepreneur of all time and then just come back to school during this leave of absence," or deferral thing that I'm on right now. And that was the first time where I was like, "Oh, you know what? I think you're right." And the truth was I decided to just continue to let the summer go by to think about the decision a little bit more before I formally submitted my deferral to HBS.

As the markets turned, we realized that we needed to hire internally to save on cash burn a little bit. And so once I had built this really awesome team that I'm so lucky to be surrounded by, that's when I was, you know, without a doubt in my mind, I was like, I got to keep pushing for this because now we have this awesome team that just wants to keep driving this mission forward. And we were getting traction. We were talking to hundreds of doctors over the summer. We were talking to health brands. And it really felt like we were onto something.

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WILL: I hear you have an amazing product team. How did you go about searching and building the right team?

IRFAN: We got lucky in a second way because of timing, where the first time was I raised the capital when the market was really hot in April. And then, I started hiring when the market crashed. And, unfortunately, as you all know, lots of people have been getting laid off since the summer, particularly in the tech world: designers, engineers, marketers, et cetera.

Now, all of a sudden, there was a flood of really great talent on the market. And that was also what spurred me to start thinking about hiring sooner than I was originally planning to. My forecast was to hire people end of this year, maybe in a month or so from now, to start that process. Versus, we ended up making our first full-time hire, I guess in July, maybe.

And it was...the best way I can describe it is like dominoes falling where once you get the first one in, then it builds trust and credibility, and then the next one comes, and the next one. And so the first couple of folks were these two brilliant engineers who were close friends of my interim CTO and classmate, Amit, who was helping us build the foundation of the product this past summer.

He did an amazing job of basically recruiting one engineer, Anand, our first engineer who started his career as a PM at Microsoft and then turned into a software engineer at a number of different startups and studied comp sci and electrical engineering at Berkeley with Amit, where they first met.

And then the second engineer was Nupur, who was a colleague of Amit, a machine learning engineer at Google Brain and the moonshot X team at Alphabet. And they were both, I think, just kind of tired of big tech and were ready to bet on the upside and their career. And the timing was right based on where the market conditions were. And so they decided to take the leap of faith with me.

And then after that, or around that time, kind of in the middle, we were able to bring on our head of design, Jakub, who is like a unicorn human with so much rich experience in the product world. So he was a computer animator and then studied visual arts, but then started his career very early in the coupon website space as a product designer actually. And then led product design as a founding designer at a number of different startups. And then, most recently, was a senior product designer at Roman, which is a really large digital health company similar to Everlywell.

And Ro, Everlywell, Truepill, all these companies had mass layoffs in the middle of the summer. And so when Jakub took my call...He talks about a really funny story where he wasn't taking me seriously at all. Convincing these excellent, talented people to come join my dinky startup at the time was not easy.

WILL: [laughs]

IRFAN: And so he just kind of took it because there was a mutual connection. Or he just said, okay, I'll explore what's going on given how crazy the market is. But once he heard what we were building, he was immediately on board, actually, because Roman has also struggled with the same customer acquisition problems. And it's a huge reason why a lot of these digital health companies continue to remain unprofitable. And so he understood the problem deeper than I think anyone because of the experience he had in the same space that we were in. And he realized that there was an opportunity to build a solution to solve these problems.

So that was the first core team. And then from there, it kind of just snowballed, you know, there was more and more interest from other folks to join. And we brought in a great junior product designer. We just hired our platform engineer. But that was the original core team from the summer who took the big leap of faith and joined because of the market conditions, the belief in the space.

And we actually just met up in San Diego for the first time for a company retreat in person. And it was just fun meeting everyone in person for the first time because now I get to know them as real people and see all their personalities. And we're really psyched about coming to product launch pretty soon here.

VICTORIA: That's wonderful and, you know, that compelling vision and having those first initial people join and brought in everyone else. You know, I think part of the reason people are hesitant to join startups is because there is that reputation for kind of unhealthy work-life balance. So you're a healthcare startup. So how do you start the culture of your company on a level where there is that balance and people want to join because it has a good culture?

IRFAN: It's a super interesting question that we spent a lot of time actually talking about in San Diego as a team. And it was brought up because I have a somewhat unhealthy relationship with work. And I am constantly working. And this is the most important thing right now in our life. And so Nupur, one of our engineers, had a phenomenal analogy that I think is the right framework to think about this from a company culture perspective.

Because I've always tried to share with a team, like, I don't expect them to work nearly as much as I do, and I don't want them to either. I think the analogy was such a fun, helpful way to think about why that was the case. And so she kind of said, "I'm like the aunt, and you're like the single father. And the aunt doesn't have to take care of the baby at nighttime and on the weekends, but the single father does. And it's not that the aunt doesn't care about the company, but there's some space and boundary in that relationship."

And so that's actually our motto right now is like, yeah, we all care about this product and this company, quote, unquote, "baby," but there's always biologically intrinsically going to be a deeper relationship between me and this company, for good reason. And so that is going to require me to work harder and longer than anyone else, probably for a long, long time. And I had to be ready for that. My wife and I had to be ready for that.

And so far, honestly, I've never been busier. But I've also never been...or, like, I've never had this ratio between busyness and stress where I'm really busy but not that stressed. And I think it's just because I love what I'm doing every day. I haven't ever found this happy balance where I actually just enjoy what I do. And I'm constantly excited about continuing to build the right product to help people.

WILL: Wow.

VICTORIA: I'm actually babysitting my niece and nephew this weekend. [laughter] My brother would say, "You need to be here on the weekends with them."

IRFAN: Maybe not the perfect analogy. But--

VICTORIA: I like it, though. It makes sense. [laughs]

WILL: There's a difference. [laughter]

VICTORIA: Oh yeah. Will knows; he's a dad.

WILL: Yeah. I know company values can be so...we have them. Do we follow them? Or sometimes they get put on the shelf. I was reading your company values, "People first, bias for curiosity, and dream big." For Frontrow Health, how does that play a role in the day-to-day?

IRFAN: When Jakub, Nupur, and Anand had all joined like that first core team, we actually spent time writing all this out and creating a document that discussed what the company culture and values were. And we looked at different examples of other companies. Amazon famously has, I don't know, these 16 principles. And we kind of said, okay, we want to pick just a couple because you can't always focus on everything at the same time. And we need some sort of guiding North Star if you will.

And so these were the three that we came up with, the ones that you mentioned. So we are people first; we have a bias for curiosity, and we want to dream big. So people first to us means that our mission like we talked about, we want to increase access to healthcare at home for the average American. And so every decision that we make at the company has to pass that litmus test first.

Whatever feature we're building, whatever business model approach we're taking, whatever go–to–market approach that we're taking, is what we're doing going to increase access to healthcare at home for the average American? Yes? Then we continue onwards, and then we continue deliberating and deciding; if not, we pass. And so that is how we determine whether we can continue to be people first because that is our mission.

And as we're going down that thread, we want to push ourselves to constantly be bettering and asking questions about how we can be better. That is the bias for curiosity. That was one of Everlywell's company values and was the one that I resonated with the most. I find tremendous value in asking questions. Nupur on our team, one of our engineers, is a great example of bias for curiosity. She's constantly challenging and asking the right questions. And that helps us be better at being people first and increasing access even more than we can because we're never settled with what exists today.

And then dreaming big is about finding answers to those questions and not settling for the tried and true paths. Some of the greatest companies that have ever been created are the ones that invent new behaviors that have never existed before. So Airbnb, now all of a sudden, people are comfortable with strangers living in their homes. Uber, now all of a sudden, people are comfortable driving in a stranger's car.

At Frontrow Health, we're dreaming big in a world where doctors are not currently engaging with their patients related to their home health and wellness journeys when they leave the four walls of their clinic. How can we change the behavior where doctors are more involved in that relationship in a way that doesn't exist today? And so that's a part of what we're trying to do, and dreaming big to go and increase access, like I said, is our ultimate North Star.

WILL: Wow. You said something I think that was...it seemed very small, but I think it said a lot about you and your company. You said that you encourage your engineer to ask the hard questions. I think so many times, people hate the hard questions. They are fearful of that. But I think in your field, you have to be able to ask the hard questions. So that's amazing that you brought that up, and you're talking about that.

IRFAN: Yeah. And it doesn't...it's not just me, for sure. I think my team is...and it's kind of you to point that out. But yeah, my team does such a great job of holding true to these values on their own and pushing me to remind myself of these values. Nupur actually is Slacking me right now about some thought that she had coming out of a meeting.

WILL: [laughs]

IRFAN: And two points about different alternative ways to think about things. And yeah, I want to keep encouraging them and our future employees to do that. Because you look at the worst examples in healthcare, in particular, tech as well, the worst examples of companies are the ones where the employees were not able to or encouraged to ask questions; that's when things go south.

So Theranos is the simplest example of this where they were hiding everything from their employees, and people had questions constantly but never asked them. And that's when more and more bad decisions were made. So I don't want that to be the case for Frontrow. And so it has to start with, yeah, this bias for curiosity.

VICTORIA: That makes sense. And I wonder if that's part of your success, being someone who doesn't have a background in engineering or programming specifically and enabling your technical team to build what they need to get done.

IRFAN: Yeah. I can't honestly explain to you guys how much I've learned over the past six months from my product and dev team. And you're right that I think one could see my lack of programming as a weakness which, in a lot of ways, it is. But what has also manifested as a result of that is I have naturally had to lean more heavily on my dev team to be owners of decisions that affect our business and to challenge them to think about are we being people first if we build and design solutions in the way that you're describing?

I don't know the right approach about how to build this, or on what tech stack, or in what capacity we have the ability to. You guys have to take ownership of thinking through those, solving those problems, and coming up with the right decision. And as a founder, that's scary to do. You're giving up control of the decisions to others. But at the same time, by giving them that autonomy and encouraging them to take ownership of it, they feel I think more and more invested in what we're building. And that hopefully builds the habit of what you guys were talking about around wanting to constantly seek better solutions, challenge because they know that they have a voice in how things turn out.

VICTORIA: Right. Maybe you've discovered this naturally or through your education and background. But studies that are done around high-performing technology organizations find that no matter what processes or tools you have if you have that high-trust environment, you'll have better security, more software development throughput, all of those things. So I think you're doing it right by setting your values and creating that kind of high-trust environment.

IRFAN: Super interesting. I didn't know that, actually, but it makes sense. [laughs] We've been seeing it. I actually want to give some credit to thoughtbot because thoughtbot helped us set a lot of this important engineering culture at the very beginning, where I had to rely on my thoughtbot engineers, folks like Jesse, Dave, and others, to help me make the best decision for my company.

They taught me a lot of these things at the earliest stage back in May around, okay, like, you guys are a consulting firm at the end of the day, technically speaking. But they pushed me to think of it more as how do we co-make these decisions? Like, how do we leverage each other's strengths to make the right decisions?

The thoughtbot design team and engineering team...one of our designers through thoughtbot, Steven, is so funny because...and I gave him this feedback, which is great feedback, which is like, he constantly asked questions. And if he hears this, he'll laugh because he's constantly pushing, like, "Why are we designing it this way? Why do you think it should be this way? Where is the evidence that the user wants it to be this way?" And it was a great setup for when our internal team came on because I just kept up that momentum. And then they just kind of took with it and ran.

VICTORIA: How did you find us, or how did you find the right technical partners in the very beginning to help you build your vision?

IRFAN: It was not an immediately simple process. But when I found thoughtbot, it kind of unraveled quite quickly in a good way. So I was working with Amit like I mentioned, who'll become our interim CTO, one of my classmates at HBS. And he helped me put together an RFP where we outlined all the different feature requirements, all the different intentions for our solution or timeline, our costs, et cetera.

And I just did a lot of Google research about different dev shops, and I started talking to dev shops in lots of different locations, U.S.-based, European-based, Asian-based, Latin America-based, started comparing prices. We had questions where we wanted to see their creativity in developing solutions. We started accepting proposals, reviewing those proposals.

I somehow stumbled upon thoughtbot's website during this process. And I noticed that Everlywell was one of thoughtbot's clients, Everlywell, the home lab testing company that I used to work at before business school. I was like, oh wow. I knew that our engineering team and our engineering leadership had a really high bar for when we worked with outsourced talent. And so I thought that that spoke volumes about choosing thoughtbot.

And so then we actually ended up asking Everlywell CTO an unprompted question of like, "If you had to pick any dev house that you've known or have worked with, et cetera, that was supposed to build you custom software from scratch, who would you pick?" And he said, "thoughtbot." It wasn't even like a question of, what do you think of thoughtbot? Or, what was your experience? It was just like, imagine you had to pick, and, unprompted, he said thoughtbot. So that was actually what did it for me.

And I kind of threw aside all the other logistical hoopla that we were going through and said, you know, I got to trust the people who I know and trust, and having verbal confirmation of that was huge. And then, of course, I enjoyed speaking with Dawn at thoughtbot, who was helping broker the whole discussion, and it felt easy. And their proposal was also quite strong. And then, as I dug deeper into thoughtbot, it became clear that no pun intended, you guys are kind of the thought leaders in a lot of ways.

WILL: [laughs]

IRFAN: It's funny, our head of design, Jakub, when I mentioned that he's a unicorn, it's because he also taught himself coding and programming.

WILL: Wow.

IRFAN: So he's like a pseudo designer and programmer. He can do a little bit of everything. And he actually...when I told him that we were working with thoughtbot, he was like, "Oh, I learned Ruby on Rails back in the day from thoughtbot with whatever content they had published back in time." And then, as I spoke to other dev shops about going with thoughtbot, they started saying things like, "Oh, thoughtbot, yeah, they're kind of the OGs of Rails and a lot of the core tech stack that's been around for a while." And so it was just continued validation of the right approach.

And then, we started working with the team in May, right after my second semester of business school ended. And it's been an incredible process. We have never missed any deadlines, and we're actually two months ahead of schedule. And it's not just because they're good at what they do, but it's also because of the culture and the teaching me about the best way to run retros, and sprint planning, and things to think about in terms of trust in your engineer and building that trust, and all the soft, intangible things. It wasn't just like thoughtbot came in and built code. It was thoughtbot came in and helped establish the company in a lot of ways.

VICTORIA: That's great to hear. Thank you for saying all those wonderful things. I'm sure me and Will agree 100%.

[laughter]

IRFAN: Yeah, it's been an awesome process. And yeah, we've even ended up basically bringing on as a full-time independent contractor someone who worked through thoughtbot because we love them so much. And they were just so excellent at what they did. And just, yeah, I think that probably speaks the most volumes about the kind of organization that you guys are running.

WILL: I appreciate you saying that. That means a lot. It really does. I want to take a second to kind of circle back and kind of talk about how you find the providers because I think, for me, one of the most influential classes I had in college was my professor said, "Hey, meet me at the pharmacy." So we went to the pharmacy, and he started asking us questions. And he was like, "What medicine do you think would be the most impactful?" And we would try to pull it out. He taught us how to compare the active ingredients.

IRFAN: Wow.

WILL: Like how some stuff is just marketing, and it's not really helpful and things like that. But I also saw the side, you know, the amazing providers like your parents. You talking about your parents just reminded me of my parents and how supportive they are. So it's just amazing. You had your parents as providers. How did you find providers beyond that that you have to extend that trust to them?

IRFAN: I guess two reactions. The first is how do we talk to doctors to get feedback on our solution as we're building it? And then how do we get doctors to sign up and use our solution with their patients? Those are the two chronological steps. So for the first one, we very liberally use a platform called usertesting.com, which we used at Everlywell, where I first got introduced to it. And it's amazing.

We have the unlimited package, and we run tons of user tests a day. So, over the summer, we were literally having unmoderated tests from medical professionals, about ten healthcare professionals a day who were coming to our website, coming to our product, giving their feedback through these unmoderated tests. We were quantitatively assessing qualitatively assessing their responses to specific questions that we were asking them.

Like, was it easy enough to write a review? What were you expecting to see? How did that compare to what you did see? Like, all the traditional kind of user research. They really helped us build the product, and then we were able to follow up with them, get on the phone with them, ask them more questions about their experience, about their current experience in their clinic, whether patients are asking them about these things, about their interest in certain supplements, et cetera.

And then we actually had one medical provider, a family practice nurse practitioner from Vermont, who was so excited about what we were building. She was sending me all this other information and content about how to reach out to other doctors and stuff. And then, at the end of the summer, when we were just about ready to start getting our beta off the ground, we were going to choose one provider to work with who was going to recommend it to their patients, and they were going to slowly kind of monitor the experience.

This nurse practitioner actually just happened to reach back out, and we happened to connect again. And she's like, "Okay, what are you guys up to? Are you guys done with your product? I really want to use it." And I was like, "Oh, wow. Well, it's great timing because we're looking for our first medical provider."

WILL: [laughs]

IRFAN: And so that's where we ended up launching beta with, which was awesome. And since then, I've been spending a lot of time thinking about the go-to-market approach beyond just one medical provider. How do we scale to thousands of medical providers? And luckily, selling to doctors is a solved problem, like; the biopharma and medical device industry has been doing this for decades.

And so it was really just a part of me brushing up on a lot of the work that I was doing in life science consulting about helping Big Pharma and whatnot go to market and just stealing a lot of notes out of their playbook. So, for example, there are companies that allow you to run ads online that just target physicians. So instead of my dad seeing a Lululemon ad while he's reading The Wall Street Journal, he'll see an ad for Frontrow Health.

And so we actually run marketing tests over the summer, towards the end of the summer, with a newer provider landing page that we had built to see what percent were going to click on the ads, what percent were going to come to the website and sign up, and then how much cost would that be per acquisition of a provider. And the results were actually much better than we thought. It was half as expensive as what we originally predicted, which is awesome.

WILL: Wow.

IRFAN: And that was before Jakub, our new head of design, had even touched the website. We're actually just revamping it right now because he's been going through and revamping other aspects of our product and marketing experience. And now we're at the provider part. So we're actually going to be just about a week or so away from launching the marketing tests and actually getting every day more providers on the platform.

The product is now done, so they can start getting their patients on the platform. We just signed our first health brand. So now people are getting real product recommendations and getting ability to earn cashback. And we can be revenue generating, which is also super exciting that we're, like I said, a couple of months ahead of schedule, actually.

VICTORIA: That's really exciting, and that certainly sounds like enough on your plate. But is there anything else on the horizon for Frontrow Health that you're excited about?

IRFAN: Yes. We are super excited that we're just coming out of stealth mode and launching our full product experience for consumers, medical providers, and DTC health brands. Going forward into 2023, we're really looking to try to find this quote, unquote, "product market fit." Are doctors excited about signing up and getting their patients on the platform? Are those patients excited about the products that we're selling on our marketplace? And are we delivering new lifetime customers for these health brands at a more cost-effective rate than they've ever seen before? And solving that original problem that came to me while I was at Everlywell.

And by doing all three of those things, hopefully, we'll begin to increase access to healthcare at home where people who are not suburban high-income folks who can afford to pay out of pocket for preventative healthcare; we can now make that more equitable by bringing down the cost through the cashback, by introducing the element of trust, by engaging with a medical provider, and by opening up people's eyes to thousands of different consumer health and wellness companies that now exist in the world that we want to be able to connect the right products to the right people with.

VICTORIA: That's so exciting. I'm really glad we got a chance to talk to you today and hear more about your story. Is there anything else that you want to add before we wrap up?

IRFAN: This has been super fun being able to even just reflect and think about our whole story. For anyone else listening who's interested or excited about entrepreneurship, there's a really good book that I read last summer as I started thinking about entrepreneurship for the first time called "The Hard Thing About Hard Things" written by Ben Horowitz, who co-founded the VC fund, Andreessen Horowitz. He was an entrepreneur himself.

And it's one of my favorite books because, as the title [laughs] explains, it just talks about the difficulty of the experience and the journey that's still ahead of me. But I think the overall takeaway of the book and my experience over the past year is that it's just the single greatest learning experience of my life.

And that's actually really all I'm trying to optimize for personally is I want to keep growing and learning, and learning about the space, learning about myself, learning about how to work on a team, how to lead a team, how to grow a team. And if you're at all interested in any of those things, keep trying to think about all the right problems that are being experienced in the world. And we still live in a world wrought with problems and don't have nearly enough founders trying to go and solve all of them.

VICTORIA: That's a really great perspective, I think, to bring to it about your own personal growth. And that's what it's really all about. [laughs] And hopefully, we're able to solve some big challenging problems along the way.

IRFAN: Hope so.

WILL: You can subscribe to this show and find notes along with a complete transcript for this episode at giantrobots.fm.

VICTORIA: If you have questions or comments, email us at hosts@giantrobots.fm.

WILL: You can find me on Twitter @will23larry.

VICTORIA: And you can find me on Twitter @victori_ousg.

This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore.

WILL: Thanks for listening. See you next time.

ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com.

Special Guest: Irfan Alam.

Sponsored By:

• thoughtbot Incubator: thoughtbot is thrilled to announce our own incubator launching this year. If you are a non-technical founding team with a business idea that involves a web or mobile app, we encourage you to apply for our eight-week program. We'll help you move forward with confidence in your team, your product vision, and a roadmap for getting you there. Learn more and apply at tbot.io/incubator.

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