Focus, validation, and the future of women's health: A conversation with Jill Angelo of Oura

[on-hold music] My name is Unity Stoakes, co-founder at StartUp Health. And I am extremely excited because we are back with an alumni from StartUp Health, a Health Transformer extraordinaire, Jill Angelo, who many of you may know already. Today will be a reunion of sorts. As I mentioned, Jill, you really need little introduction to this community.

What is so awesome is that you are also have been a startup founder, but many people may not know you've also been an executive for many years with Microsoft, and now you are a commercial leader at really one of the most, I think, important health companies today as one of the senior leaders at Oura. So we're gonna talk all about that. But just to remind everyone, Jill built a really important women's health company called Geneve. Jill is one of the pioneers of the women's health category in digital health.

This was a StartUp Health company. Jill navigated an acquisition, and really went through the whole journey over many years. So Jill has been where many of you are today. But really, Jill, you've sat at every seat at the table, and now you're doing these extraordinary things that I think are really important to the ecosystem at large, the work you're doing at Oura, the work you're doing still in women's health.

So we're gonna dig in and learn from your wisdom. I'm personally so grateful you're here, and I can say from firsthand experience, I learned a tremendous amount from your wisdom and expertise and kindness along the way, so thank you, Jill. Reminder to all the members and Health Transformers here today, this is an opportunity to make this interactive. But Jill, welcome.

Thank you for being here. How are you? I'm great. I'm really awesome.

Unity, it's really fun to be back. This - I feel like this is like homecoming in a way because y- you saw me through some of the hardest trenches as a StartUp Health Transformer. Wow, what an incredible impact that every bit of the experience in this community has had on me during that phase of building a business and taking it through an acquisition. You saw me through that too, and it's just really fun to be back here.

It is fun because y- we're at a much different time. We're at a much different moment, and you're sitting at a really important seat at, I think, one of the most consequential companies in technology, but also specifically health technology, and also, I think, paving the way from the work that you've pioneered around women's health as well. So I hope we get a chance to dig into that. Can you just update us on what your role is?

Maybe, uh, for those... I'm sure everyone knows what Oura is, but how you define Oura and what your role is there today. Yeah, absolutely. My role is VP of Women's Health and Commercial Partnerships at Oura.

So Oura, if you're not familiar with Oura, wearable company ring, the leading wearable company in the ring space. The company's been around 13 years. We - early on, our bread and butter was tracking sleep. That's why we started.

Our founders were in Finland, so we're a Finnish-based company originally, designed the ring largely to track sleep patterns in people, and over time evolved the biometric data that the ring was able to collect to temperature, to heart rate variability, to respiratory rate, to over 50 biomarkers that now we take that data, we correlate it to serve users in all aspects of their health and wellness. Specifically, we've hu- found a huge application for women's health. When you track temperature, when you track heart rate variability and respiratory rate aligned with sleep, you learn a lot about a woman and her rhythms, namely her cycle.

And so that has led us into building out capabilities for cycle tracking, for women who are trying to prevent pregnancy, so birth control, to women who are trying to conceive, women who are pregnant, going into menopause, trying to manage their cardiovascular health and beyond. Today, our audience is predominantly women, but we have a large male community as well that utilize the ring for just overall health and wellness. I would say 55% of our users buy the ring for managing a chronic illness or issue, and the majority of members purchase the device to drive some sort of behavior change.

Either wha- whether that is to manage their chronic i- illness, whether that is to prevent a pregnancy, whether that is to try to achieve a high performance physique and body. Again, my role specifically is really focused. I joined last July to really build the women's health business. As mentioned, I spent a long time at Microsoft, left there to start Geneve.

Spent about 10 years in the women's health menopausal. I would say we were the first company kind of focusing on menopause. Early days, sometimes you could say almost too early. Led that company over the course of 10 years through an acquisition, and last March, as I was rolling out, we had integrated the team within the acquiring company.

I was just ready for about 12 months of break. I've never taken a career break, and as you all know, as startup entrepreneurs, it's exhausting. And so I was planning to take six to 12 months and was spending some time advising different women's health companies, and one of my former investors connected me with Oura, asking me to meet with them, and they... one thing led to another, and they asked me to join to bring on to help them build out the women's health business.

And so I've really, as an operator, it's fun to be an operator in a company again. I mentioned to Unity, this is a dream job for me simply because it blends together my tech background with women's health, and so together I get to use just the experiences, the failings and the successes now for Oura.I guess my question for you is, what's your just larger perspective on the state of where you are, if you put your founder cap back on, of the moment now compared to, say, a few years ago?

What's changed? What would you say to all these founders now is the tenor of the market, and what it might be like to be operating and building today verse being a little earlier a few years ago? Yeah. I'd say specific to healthcare in general, but I'm gonna start with women's health and then I'll extrapolate that to healthcare in general.

I think with regard to h- to women's health, it's less convincing that it's meaningful and important in terms of investment or in terms of partnership or collaboration or even joining the company. The why is just, you don't even have to explain why. You, you more so really shift to the how are you sustainably going to support her throughout her life? So we're looking more so at longitudinally the importance of supporting an individual.

As you think about women's health, there's how it started was really tackling problem after problem, and they were all specific problems impacting large populations, whether it was menopause, whether it was endometriosis, whether it's fertility, whether it's partum. It was all parts. And now as we think about women's health and the questions I receive is, how are you thinking about her throughout her life? Because healthcare and a woman's health is connected.

It's not just one thing or another. Her pregnancy is connected to her cardiovascular health. Her sleep quality is connected to her menopausal health. And or her menopause impacts of quality of life.

And so it's looking at her more holistically is probably one of the big changes versus just how are you trying to focus on this one problem and why it's important. And we don't have to explain the why as much. We just get to talk about what we're doing, and then you think bigger as a result. As it comes to healthcare, and I think even the changes so much even when I was going through it early on 10 years ago, it was often focused on how it's really hard to change.

It's, it moves really slowly. It's i- if you come from tech, you're not gonna be able to just insert yourself and make a quick change. I think that still exists. All those realities are still there.

But I do think healthcare is at an interesting place, both geopolitically all the way down to what AI's bringing, down to what all of these companies are doing in terms of innovation. It's moving faster. There's more opportunities to integrate. There's more programs.

It's almost, oh gosh, did we apply to that and did we get on this? At Oura, it doesn't matter how big you are, we still consider ourselves a startup. We might be a well-capitalized startup, but we're looking at every opportunity to connect with the opportunities that are now popping up in healthcare, and I think there's just so many more of them. Yeah.

And it's like, where do you pick and what do you do? Because you can't do them all, and I think that's almost like a bigger challenge now than scarcity as it was maybe 10 years ago. As you said, 10 years ago we were just all going out and explaining why this even matters, and now there's big Fortune 100 companies that are maybe not the usual healthcare companies that are now partnering with companies like yours and companies like the ones on this call that are trying to figure out how to integrate, collaborate, design health into their solution because it benefits their members or their product or their solution.

What's going on today? What's the market look like? What are some of the types of partnerships that you're seeing or working on perhaps? I'll start with one that the company's so grounded in, and that's research and science.

Now, this isn't capital producing, but it is largely this drive to get to outcomes that makes your solution relevant in the healthcare ecosystem of how the money flows. And so when we think about a large chunk of partners that we work with, they are research, they are third-party academic organizations. They are pharmaceutical companies. We have a lot of inbound from pharmaceutical companies now simply because we've got this continuous always-on data monitoring device on so many fingers.

Over five million fingers around the world. I think the bigger revenue opportunity there is truly around publishing outcomes and making your solution relevant, and that is the currency that unlocks access, whether that is reimbursement or subsidy in some sort of way. So I'll put partnerships, that's very hot. We're managing a lot of those right now.

The second category is truly just really integration partners. Organizations that are ingesting, that connect with us on an API level, that ingest Oura data to improve the value prop to their users. And then the third category is really this notion of connected care. We are good at helping members understand what's happening in their bodies and why, but this what do I do next is the big unanswered question.

That's at the crux of healthcare. Getting the help you need, the care you need, whether you go to your favorite AI advisor to help you answer some of your questions, or whether you go to a clinician. That connected care aspect and how we integrate with health systems, with digital health partners, with different organizations. Wow, so much to unpack here.

That first category, you talked about validation. And even as a mega startup, a fast-growing company that's been around for years, it's interesting to hear you're still validating. You're constantly validating, and those types of partnerships are so important it sounds like. Why should all the companies and startups on this Fireside Chat be thinking about validating as a key pillar to their solution as, as well?

Obviously, there's so much data out there, and there's so many opportunities to integrate from a outcomes research perspective. I, I think a big part of where we're picking and choosing is there is... You can do a lot, and it takes a lot of resources. And even for a company like us where we have built an outcomes team that just runs this stuff, we looked at a roadmap of all the studies that we're, we have underway right now, and we were like, this is almost untenable.

If we started with one or two most meaningful ones that start the ball rolling, it's, there's a flywheel effect to outcomes and that you're able to prove. And if you just get one, it's gonna make the others easier to unlock and/or believable by the people that are going to be consuming it. So if you think about a payer that wants outcomes before they're, they'll provide reimbursement for your device or for your service or for your solution in any way, just getting that one success and the trust and the, a little bit of validation that, yep, you know how to do this, you've got proven outcomes, this payer is now willing to reimburse you for that as a result, it signals things to others, to other payers, to a CMS, to single payer health systems around the world that you're a utility that they can trust because of a success that you've had or successes you've had.

And now that you've been on so many sides of the table over so many years and the state of the industry has evolved, I think, in, in such important ways, what do you know today that you wish you had known as you were building your last startup that would be helpful to help focus the innovators on this call earlier? Have you had any of those insights? I think there's probably a lot I would've done maybe differently. Startup is a process of eliminating the failures or learning from the failures and elimination.

But I would say one key thing is focus on the intention for your end user that you're building your solution for versus how am I gonna get it sold in? 'Cause I think so often for survival as a startup, you think about how am I gonna get it paid for? How am I gonna get... Who's gonna pay?

How am I gonna get it paid for? A- and those are, you have to focus on that, but it sometimes usurps the intention for why a user would use your solution, your app, your service, your device, your data, you name it. And so getting back to staying grounded in that initial intention, I think oftentimes in my past journey where I feel like we tried to grow artificially when we got overly focused on a broader healthcare ecosystem player that we eventually knew we wanted to subsidize, reimburse us, pay for our solution.

But that became the focus versus what were the signals and the successes that we had with the user. So in my case, I'll give you one example. We, with Geneve, we were a 50-state telehealth platform specializing in menopause care, and I wanted to move into the employer space. I wanted this to be part of employer benefits, and we were having to convince that this mattered to retain their perimenopausal workforce.

But then also they wanted us, employers wanted 50-state solutions, and then they wanted not a point solution, but something more broadly. So then we were like, "Okay, can we do primary care as well as some longevity and whatever?" So we were always reshaping our solution to what employers might want to bring into their organization versus really honing in on showing insane success within a smaller space. So if I were to do it again, I would've looked at how did we grow radically across maybe three markets before I focused on the expense of going to all 50 states and all the regulatory hurdles and licensing we needed to do and, a- and also all the pitching to employers.

I would've focused on a smaller set of really high signaled success in a smaller space, whether that be market, whether that be with a certain type of user, because to me, that shows sustainability, and oftentimes we're attracted to look bigger than we are sooner than we should. Mm. And I think to this day, even some of those same lessons, we still, even at Aura, okay, what's the intention of this particular user that made us successful in this space, and how do we make sure that we are just showing wild and crazy success that any other entity wouldn't want a part of that?

And so th- that to me is probably the most near term lesson that still holds true to today. Yeah. That focus in every way is such an important theme. The product focus, the experience focus, you mentioned privacy, building trust, that all builds that trust, and then even focusing on the early markets.

I think that's a really big insight. We have a bunch of questions that are stacking up, so I'm gonna start calling on people. Emmett Scheller from Held, if you could introduce yourself and ask your question, Emmett. It's so nice to meet you, Jill.

I'm Emmett Scheller, founder of Held Health. We are a shared health command center for people serious about longevity, and Aura is an integrated partner of ours. When you think about Aura and focus, when you think about what Aura does between health insights-... health management and health care.

Where is Oura's focus today, and where do you think it could be in the future? Thank you for being a partner. Building an ecosystem, I think, is how we all really make an impact together. Thank you for that.

I think as we think about kind of those, we help the user understand what's happening, why, and then what do I do next. Obviously, what we have seen in terms of why people buy the ring and how it's, how it's being useful is in this notion of behavior change as well as detection. During the COVID era, if you use an Oura ring, there is a feature called Symptom Radar, and it was a feature that was built. We could almost identify early on if an individual was going to get COVID through some of the biometric data that we were collecting.

And so the team developed Symptom Radar. It's been live now for a couple of years, and it's just become wildly successful. We hear about it's the reason why people buy the ring and/or continue to use it. Our retention's really strong.

And so it's detecting something for the user that they wouldn't otherwise know in advance of it actually happening. We can see a lot of things that we don't make claims on today. Can we, in the future, tell a woman, "Hmm, we're seeing some things. Maybe you should take a pregnancy test," or some s- sleep disturbances, "Maybe you should check for sleep apnea."

Those applications in the area of hypertension and cardiovascular health, those are detection capabilities that, gosh, you know, if... How valuable to users to get ahead of it and/or to detect, to not take the place of diagnosis, we're not diagnosing, but to move the user to go seek care. I think it, especially in women's health, the biggest competitor to care is women just not doing anything. Men might be more apt to do something.

But nonetheless, to make those claims, we have to, in many cases, really receive medical device clearance. And so there's a huge FDA regulatory roadmap piece of work underway in that space. The second area is really this notion around behavior change, and [lips smack] behavior change specific to lots of things, but one area you'll see us moving into is medication adherence. Last week, we made a big announcement about a smaller ring with a number of different features, and one of those features is what we call the GLP-1 Companion.

And what that does, it allows you, if you're utilizing a GLP-1, to see its impacts on the biometrics in your body, and as a result, hopefully help the member manage through those gnarly side effects so that they stay on the medication longer, and it drives up adherence. That application across other medications is a sure reality in the future. Next up, Venkat Ramamurthy from TrackHealth AI. How are you?

Hi, Unity. Thank you. I'm a founder of TrackHealth AI. We are looking at all the moments, transitions of care moments, from a post-discharge workflow when the patient leaves the hospital, but from a family and caregiver nudging the patient to track to adherence.

How do you drive behavior change when you're thinking about a longer term longitudinal care? It's at the core of what we do. When you think about behavior change, it starts with helping the user understand the what now, and then showing the trends over time. We often say we really wanna move in healthcare from episodic care to longit- longitudinal, continuous, always on, because a lot of health happens in between doctor's visits.

And so if you're able to demonstrate and show to the user the trends over time, when you correlate that back to changed behavior and you're taking those things in the app or if you're utilizing and wearing the continuous glucose monitor, I know for me, I put on the continuous glucose monitor a few months ago, and I'm just observing how my glucose jumps. I'm not diabetic. I'm, but I know that I can ensure stronger energy and cognitive just clarity by eating more constantly, and it helps me monitor that.

So as a result, I've changed my behavior just by watching the data. And so it's truly in how you surface that for the user and prompt them every once in a while, and that's where we see the big behavior shifts change, is in terms of helping people see the trends and reporting that back to them on a regular basis. I think the more we can think outside of the actual device to how we can sense things, that's where the future is. Because whether it's a watch, whether it's a ring, whether it's a patch, whether it's an ear implant, we're seeing everything.

And form factor aside, I think the potential of sensing and correlating is just the, the opportunities are endless. Thanks, Unity. I appreciate you having me. I'm so glad to see all the incredible ongoing innovation.

It's much needed. All right. Thanks, everyone. Have a wonderful week.

We will see you all soon. Bye, Jill. Thank you. [upbeat music] And finally, an invitation to all of the extraordinary health transformers, whether you are a startup, someone building the future of health, or whether you are an investor, funder, or buyer of the solutions out there in the marketplace, this is an invitation to you to join the Startup Health member community.

Learn more at startuphealth.com. Look forward to hopefully seeing you soon.