🎙️ Ride Health CEO Imran Cronk on Better Care through Transport
🎙️ Ride Health CEO Imran Cronk on Better Care through Transport
Better Healthcare through Better Transport 🏥🚗
👋🏽 Welcome to Doing Well by Doing Good: The New Startup Model, a newsletter and podcast series highlighting the startups aiming to be profitable with a purpose.
Welcome back to our second podcast in the series! In this episode, we chat with the CEO of HealthTech startup Ride Health, Imran Cronk, to explore a topic rarely thought of for those who are fortunate enough not to worry about it — transportation to the hospital.
Imran shares with us how he was inspired to start Ride Health to help vulnerable populations access healthcare better, and how Ride Health maintains a culture true to its mission while Doing Well by Doing Good. For those looking to start or join a Doing Well by Doing Good startup, Imran also shared with us a few pointers for listeners to help navigate the waters.
Listen by clicking the button, search “Doing Well by Doing Good” on your favorite podcast app, or read the transcript below with links so you can listen in to the parts you find most interesting. Hope you enjoy!
Founding Story
Anand [0:35]: All right. Welcome Imran! Thanks for making the time.
Imran [0:39]: Yeah, absolutely. Good to be with you Anand.
Anand [0:42]: Why don't we just jump right in? How would you describe Ride Health in one line?
Imran [0:49]: So Ride Health drives access to care for vulnerable populations who face transportation barriers due to affordability, age-related or mobility-related reasons and we believe in a world where no one has to forego care, just because they can't get there.
Anand [1:08]: Makes a lot of sense. You know, honestly, that's one of the reasons we're really excited to have you. Because Ride Health certainly is Doing Well by Doing Good. Really excited to talk to you.
Imran [1:19]: Thanks for having me.
Anand [1:20]: Why don't we jump into, you know, kind of the background. So how did you get here? What was your founding journey?
Imran [1:26]: So about seven years ago, I was a volunteer in a hospital down in North Carolina, where I'm from originally, and I was doing kind of midnight or 9pm to midnight shift in the ER, and this patient was discharged, came out into the waiting area. He came up to me because I was the first person who he saw and he said that he didn't have a way of getting home. He had been taken there in an ambulance, maybe eight hours earlier, but now he was being discharged at like 11:58p and he didn't know how he was going to get home. And so I said suggested that he go over to the nurse's station to see if they could help him out with a cab voucher or a bus pass. And he went over there and talk to them. And they told him that they didn't have anything for him that you'd have to figure something else out. And so he was kind of wandering around a little aimlessly. I went up and asked him, What do you plan to do? And he said that he might try to walk home. And I asked him where he lived. And he described this part of town that was about eight or nine miles away from the facility. And this guy was like 60-65 years old, he was kind of off-balance and staggering a bit. And he told me that he had been given some medication during his stay that had compromised his vision. So he couldn't see all that well. So no part of this sounded like a good idea for this guy to just go off into the night. And so the only thing I could think to do in the moment standing there was to offer him a ride home, because my shift was ending at midnight. And so that's what happened. He took me up on it and we went out to my car, drove home and dropped him off and everything went fine.
But it was a little weird driving a total stranger home in the middle of the night, as you might imagine. And it kind of got the gears turning in my mind about why that had been the outcome of that situation. And so I became curious about the role that something as simple and taken for granted as mobility actually plays impacting people's ability to access resources or just to get home safely. And so that curiosity led me to study the issue a bit further. And a couple years later, in 2015, on kind of a fluke, ended up getting an article published in The Atlantic about the transportation barrier to healthcare. And, you know, it was still kind of an academic interest, but about a year later, I was in a business plan competition as I was wrapping up undergrad, and that opportunity, or that that process gave me the idea opportunity to flesh out more of the product vision, the value prop, the key details. We lost the business plan competition. So that was a bit of a bummer. But I felt like there was something there. And when you identify a problem like that, and you see a reasonable path toward solving it, it's kind of hard to forget that. And so about a year after that, so we're getting to 2017, I was finally able to jump full time and start the company. And that's what I've been doing ever since.
Anand [4:37]: Wow, that is a very intriguing founding story. And it makes a lot of sense. I'm curious, actually, how did how did that end up? Did that patient ever have to come back to the ER? Did you ever meet that patient again?
Imran [4:55]: It's a good question. I actually have no idea what happened. Never got any contact information for the patient. It was literally just as simple as he was there. I was going home, you need to get home and I dropped him off. So I hope he's doing doing all right wherever he is.
Anand [5:13]: Yeah, that's amazing. Well, hopefully now Ride Health can help with with that situation.
Imran [5:20]: Well, it's funny. About a year ago, we started working with the hospital that I was actually was a volunteer in. And we set up a program that started with a scope around hospital discharge. And of course, now it's expanded to all the other parts of the hospital and health system, but it was a definitely a full-circle moment.
Anand [5:40]: Wow. That is very cool. Great story. So one question around that story, you know, what challenges did you face along the way ever since 2015, 2017 and what resources have you been able to use to overcome some of those challenges?
Imran [6:01]: Yeah, absolutely great question. The challenges are kind of, you know, when you’re going through the experience of starting a company and identifying and validating your assumptions, trying to figure out the right way to grow. There can be a temptation to subsidize that growth. But we've really strived for organic growth. And really, the help has come from countless advisors and mentors along the way to get more specific. One of the key challenges we faced early on was skepticism of using new forms of mobility. So think back to 2016/2017. On Demand TNCs, Uber and Lyft were proliferating, those are just kind of the big names but they're kind of symbolic of a broader shift toward more technology-enabled and digitally-connected forms of mobility. Hospitals were almost allergic to that notion because of the perceived risk, and so we had to really overcome a lot of that and build a lot of trust. Hard to imagine now, but, you know, three or four years ago, that was certainly the case. I think another challenge that we that we faced which the every company faces is balancing your early pilots and deployments with the need to constantly be fundraising and getting resources, you know, for your organization to grow. It's an incredibly challenging balance at a very vulnerable point for a company, if you're not kind of at a standing start.
You know, I often equate it to rubbing sticks together to make a fire at that early stage, and so that was another key challenge. And then there's personnel related challenges that any company has: sometimes multiple co-founders, there can be different levels of being involved. Among those co-founders need to kind of hash those out and make sure that you're always acting in the best interest of the company long-term. When you're growing rapidly so is your employee and team base. There's an importance of building and maintaining trust among those different teams, as a company grows, and you start to have certain parts of the organization that are focused on sales and client services and other parts of the organization that are focused more on product or engineering or other functions. There's just natural tensions and trade offs that arise. How do you build that trust among those teams? And how do you do all of this when you're doing it for the first time, right. So as a first-time founder, you haven't made a lot of these mistakes before. And so you have to continually be self-aware and thoughtful enough to learn from those and accept those mistakes and those failures and move forward. So in terms of the resources that have helped navigate those challenges. Early on, we joined StartUp Health. So back in 2017, almost before I was even full time on Ride Health, we got into StartUp Health and that was really useful. They've been great from the standpoint of helping us work through a framework for building the company, connected us to an amazing community of fellow entrepreneurs or health transformers, as they call them. And that's been super valuable. Some podcasts are always good for inspiration. There's, you know, ones, everyone listens to “How I built this?”, “Masters of Scale”. And some more niche ones on the health care or mobility sides. You know, there’s some great books: “Hard Thing about Hard Things”. It was funny, I got that as a gift from some of my colleagues, maybe six months ago. Yeah, cuz they said, you're reading this at the wrong time. You should have read this three years ago. And then on the inside it says “you're the only person who would read this after doing the hard thing”. By no means have we done it, but it was still a funny note.
Mission & Culture
Anand [10:04]: No, I mean, that is a really great book. Frankly, I wish I had read it earlier as well. I really like your analogy of sticks rubbing together. I mean, that's a great analogy for starting starting a company. You know, you take whatever resources you have, and you try to make something good out of it. So yeah, absolutely. Cool. So, I wanted to transition to, you talked about personnel, right, I thought that was really interesting, and probably one of the most important things as you grow the company. So what is your company mission? And how do you create a culture that embodies that?
Imran [10:43]: Absolutely.
“We ensure that every patient everywhere can access the care and resources that they need to ensure good health.”
And I guess I could take a step back and share with folks what Ride Health actually does for a second in support of that mission. In essence, we build technology that enables hospitals and health insurance plans to manage transportation programs for their patients and members. So it's a web-based platform that care coordinators and social workers use to coordinate rides for patients who are low-income or elderly or have physical mobility limitations. And we connect to a national network of transportation providers across all levels of service from public transit, to ride hailing taxis, to non-emergency medical transportation for patients who need extra assistance door-to-door, door-to-door wheelchair accessible, up to stretcher vans and ambulance. And so that's really what we do and as I said our mission is to ensure every patient everywhere can access the care and resources that they need.
Anand [11:56]: So that makes a lot of sense. It sounds like the patients are really the focus at Ride Health helping to make sure that they can get to where they need to go. So then the question I have is as you hire people, whether it's for engineering, whether it's for product, how do you maintain that culture? Do you have certain questions that you ask people? Do you make sure that people come from a certain background that helps them understand the problem? You know, what do you do to ensure that the culture continues as you grow the company?
“Yeah. So it starts with our core values. And there's five of those we talk about: people first, intellectual humility, embrace complexity, own your outcomes, and long term mindset.”
So those five, you can kind of fit them on an index card. And they're kind of meant to be memorable, at least internally. And that feeds into the Ride Health way, which is something that we wrote perhaps a year, year and a half ago. And the Ride Health way is a set of operating principles that expand on those core values and are intended to drive day-to-day decision making.
And so for example, you know, I talked about people first as a core value. The Ride Health way expansion on that is that we put people first by believing in their dignity and worth and good intentions. So that principle kind of translates both externally, because, you know, we're working with with highly vulnerable, highly complex patients and health plan members and coordinators. And these can be very stressful situations. These can be people who are in, you know, really tough social circumstances, they're going through their medical care journey, and they're not always bringing their best selves to those situations and whether we're working with folks with our contact center, interfacing with patients or drivers or coordinators, or some of our team members on the client success side, they always keep in mind the dignity and worth of people. And those are kind of Social Work values. We've had a team member who very early on, has been a part of the company. And she came from a background of 10 years in social work, and really has upheld that value internally. The good intentions part I think, is really important when you're thinking about putting people first internally within your team. And you know, even though people will disagree on different ways to do things, I think you have to assume good intent. And that's an important principle for us.
Another example of this is: I talked about intellectual humility. The Ride Health way expansion on that is that we are intellectually humble in that we ask questions and admit mistakes. I think this is something that applies to a lot of startups where you're constantly learning new things, you're having your assumptions challenged or proven wrong. And it's really important to always ask those questions and to admit when you've made mistakes or have been off mark. So those are a couple of examples of how we create a culture that embodies and helps deliver on that mission.
Anand [15:08]: That's awesome. So those are sort of five pillars that are easily memorizable for every employee. Yeah, that's great. I think conflict is natural, and things change really fast in a startup. So you have got to have some set of core values so that you know how to resolve them and get through the challenges makes a lot of sense. That’s a very great way to maintain culture and it's quite admirable.
Imran [15:41]: Well, there's a whole lot of other things that go into it. But that's what I think it has to start with and you have to trust that that will resonate with people and that at the end of the day, the culture is upheld by all of us collectively, within the company not by some master plan.
Doing Well
Anand [15:57]: Of course. Yeah. It's a team effort. Well, I thought, you know, we could transition over to Doing Well by Doing Good. So Doing Well, obviously the first thing that's important to build a sustainable business is to have a business plan, a way to make money both in the short-term and long-term. Could you talk a little bit about the plan and the business plan of Ride Health and how you guys make money?
Imran [16:25]: Yeah, absolutely. So I think one of the most important things that any company can have early on, especially throughout their lifecycle is an understanding of unit economics. So we think about is a couple things, principally is net revenue per ride. So we are paid, in addition to the cost of the ride, which is like a pass through, there's an admin fee and that covers our costs of providing real time ride operations support, maintaining the platform and all the transactions that are happening there, and building and managing a network of transportation providers. And so when we think about our unit economics, it's that net revenue per ride. And subtracted from that is our human-driven and our technology-driven costs on a per ride basis. And that gets us to a gross contribution margin per ride. And that then translates with a couple other inputs into our overall gross margin and then net margin. And so we've, from a very early point, kind of understood that. It wasn't as though we were searching for a business model. Maybe back to what I mentioned earlier, we never believed in subsidizing growth, we always wanted to have growth that was real, real customers, investing in transportation and being willing to pay our fee on top of that because they believed in the value add of the service. And so we have had from day one, you know, positive contribution margins on a per ride basis. And those have been getting better and better. And now
“we're at the point where, based on our plans across people and technology that we have for the rest of this year, next year, it will be possible to achieve SaaS-like margins within the context of a tech-enabled service coordination business, which will be pretty exciting to realize in the coming months, and years.”
So I think that's really important for people to have thoughts around, especially in the current environment. What happened with the pandemic has been tightening valuations, it's been upping the ante for diligence. And companies that don't have clarity around this will find it much more difficult, I think, to advance.
Anand [18:52]: Right! That makes a lot of sense. So in this case, you guys are working on creating those sort of larger margins, the SaaS margins in order to create a sustainable business on a per-unit basis. And then of course, if it works on a unit basis, then it'll work at on an aggregate basis as well.
One question I have, especially doing what right health is doing and obviously being very mission-driven: Is there a case where you've seen sort of your business model go against maybe what your mission and culture is, or maybe any times where you had to make a choice? And you had to figure out how to resolve a conflict between the two?
Imran [19:43]: Yeah, it's a great question. So we, about a year and a half ago, maybe started to realize that our pricing model was off. We had been charging on a kind of a software license base — kind of a pay-per-user type model. And what we learned was that the number of users was not necessarily coordinated, correlated with the number of rides being coordinated. And that there would be some power users and that there would be some disengaged users, which is obvious in retrospect. But we thought it would kind of all balance out and turned out, it wasn't if you looked across every account. And so we had to make a decision about whether to go with more of a utilization based model, which was a little bit of a odd thing when you think about how healthcare is moving toward more sort of payment for value rather than for volume, to have a utilization based model. Philosophically, even if it's not, even if it makes more sense, and customers want to pay for it that way. It still felt a little bit odd. So we've been in that utilization-based model for, you know, a year, year and a half now. And what's interesting is that the business is now starting to shift more back into the realm of fixed fee. But you know, it's in the context of better predictability around volume at the program level. So all of that is kind of minutia that's not super relevant to your question, but I guess it was important at all stages of that decision process that we made sure that we were interrogating, and asking ourselves whether our pricing model was fitting not only with what we valued, but also what our customers valued, and that it would work for our business model itself. Because there were times when those things were not in balance. And so I think more broadly,
“to the point of how do you balance you know, shareholder value with with mission and culture it's really about joining the two together and not treating them like two separate spheres or conversations.”
I think, you know, what we try to do is to communicate to the team, what our board cares about. And we try to communicate to our board what our team cares about and what our customers care about. And I think in that context, people can make decisions about whether the environment aligns with their values. And most healthcare oriented investors are fairly mission-driven, and long-term minded to some degree anyway, and they understand the long sales cycles, they understand the opportunity to invest in making an impact and building valuable relationships. So it hasn't been I say, a huge challenge. But that's one of the things that we've thought about for the past year, year and a half, especially.
Doing Good
Anand [22:45]: Totally, now that makes a lot of sense. And it's great that you have sort of a two-way communication channel as well between the team and in the board. That's great. Let’s move on to Doing Good. In 10 years when Ride Health is a huge success, what global challenge will Ride Health have helped solve?
Imran [23:07]: Yeah, so globally, you know, health and mobility are each multi-trillion dollar sectors. What we see is that they're rarely connected in a thoughtful way. There's kind of healthcare world and mobility or transportation world. And so transportation barriers and constraints to health and other resources for that matter, are a global challenge.
“Our general endgame is to define that intersection and to solve for the problem of access to resources, connecting people with places in a manner that is impactful to their health and well being.”
Anand [23:51]: Yeah, and that is a serious problem. So it's great that you guys are solving it. And you know this is always a question that I have because of what we're talking about: Doing Well by Doing Good. Why build a for-profit business rather than a nonprofit?
Imran [24:09]: Yeah, that's great question. We considered this very early on. And at the end of the day, it was the access to diverse funding streams. And, you know, being more than just grants so you can get angel investment, venture capital, debt financing. And then, in addition to that, I think the for-profit model forces you to think earlier about self-sustainability, instead of kind of the reliance on a grant cycle that can kind of drain energy and resources from the mission. And so for us, it was a pretty easy decision, but it was one that we examined just given the inherently social nature of what we're doing, so great question.
Anand [24:59]: In terms of funding strategies I'm curious because there’s, of course, where can you get the money from? What about growth? So do you think that with the for-profit model and with the VC model, you're able to grow faster, for whatever reason, right? Because you get more funding, because you're able to focus on the business model. Do you feel like that's also one aspect of it?
Imran [25:24]: I think we absolutely have been able to grow more quickly. With that funding, you often hear the phrase, VCs sell rocket fuel, it's not for everyone or for every organization. But if you're looking to make this type of impact on a broad scale, it's definitely worthy of consideration.
Anand [25:45]: And so I guess, in this case, the rocket fuel does help.
Imran [25:52]: Absolutely.
Advice for Listeners
Anand [25:54]: Well this has been obviously very interesting and thanks again for taking the time out. For the audience, one thing that I wanted to ask before we go is, what advice would you give for somebody who either maybe a founder who wants to start a company that's Doing Well by Doing Good, or professionals that just want to work for a company like that? What advice would you give?
Imran [26:24]: Well, so I have a couple. Well, I guess it's around financing. And it's a couple pieces of advice: I think the first is about angel investors, which were very important for us early on and continue to be important partners and members of our community. Angel investors, at least those who orient toward healthcare, in my experience, are generally looking to put their money into companies that have a social mission and impact. It's a really important motivator for why they're doing that in the first place and how they choose the companies that they want to spend time with. So in those early conversations, you know, don't underestimate the importance of focusing on that aspect with angels. When you get to a later stage, and you're dealing with more institutional investors or groups, they're much more answerable to their LPs. And you'll need to bring much more to the table in terms of a long term sustainable business model. And that's where having that focus on unit economics early on, and having an airtight understanding of them will be very, very helpful. So I just wanted to kind of share that reflection looking back on our financing journey, like what mattered most at each stage, at least for us.
Anand [27:48]: That's super valuable. And it makes sense. I mean, naturally, any company that that goes through the funding process has to go through those stages. How about for professionals that want to work at a company like Ride Health, what advice would you give?
Imran [28:06]: Yeah, I would say that it's important to be realistic with yourself about the type of environment that you will thrive in. It's one thing to think about working at a company that is Doing Well by Doing Good. That's a concept I think everybody can get excited about and get behind. But I think it's important to be realistic about the stresses, challenges and trade offs that come with joining a very early stage high risk enterprise, of course, and people need to sort of be very self-aware about whether that's the environment in which they will succeed. And I think many of them can, but it's just important to ask yourself those questions and talk to people to really understand what it's going to be like, especially if you're transitioning from a more corporate environment, or just haven't been in a startup environment before.
Anand [28:58]: Absolutely. That's great advice. And with that thank you so much for being on the show. Really appreciate it!
Imran [29:07]: Yeah, thanks! These are great questions. Great conversation. Looking forward to continuing.
Thanks for reading / listening! As always, if you have any suggestions for improvements or feedback, reply to this email, email us at hello@doingwellbydoinggood.co, or tweet us at @dwdgsf.
Ciao for now 👋🏽,
Anand