- 7 minutes ago
Over nine years, Zach Reitano has repeatedly evolved Ro as patient needs and the healthcare market have changed, from its early direct-to-patient services to a leading platform for GLP-1 care.
During Business Insider’s The Long Play, Reitano discussed the business decisions behind those shifts and how the company is positioning itself for the next era of consumer health.
As part of his conversation with Business Insider legal correspondent Melia Robinson, he also shared what he’s learned as a founder leading in an era of quick and unrelenting change.
During Business Insider’s The Long Play, Reitano discussed the business decisions behind those shifts and how the company is positioning itself for the next era of consumer health.
As part of his conversation with Business Insider legal correspondent Melia Robinson, he also shared what he’s learned as a founder leading in an era of quick and unrelenting change.
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00:00Hi!
00:02Well, I'm not even going to ask who's heard of GLP-1s.
00:05I feel like the easier question is who hasn't at this point.
00:07But I will ask, for a show of hands,
00:11the brave few souls who might tell me
00:13if you have a personal connection to a GLP-1.
00:17Maybe you've been on one this year.
00:19Hi, it's me.
00:21Or maybe you know someone personally.
00:23Yep.
00:25And raise a hand also
00:27if you're at all worried about what increased use of GLP-1s might mean.
00:34Okay. All right.
00:36Well, Roe is one of the companies riding the Ozempic wave.
00:41The opportunity is massive.
00:44Morgan Stanley estimates the global market for GLP-1s
00:48will reach 190 billion by 2035, more than double 2025 levels.
00:55We're going to talk about how popular GLP-1s are,
00:59whether they're too popular,
01:01and before that, Roe's rise to the moment.
01:06Zach, you, thank you for being here.
01:08Thanks for having me.
01:08Your hair looks great, by the way.
01:14You started Roe, formerly Roman, tackling a different taboo.
01:19You started out shipping erectile dysfunction medication to people's doorsteps.
01:26Why did you start with ED?
01:28Yeah.
01:28I was customer number one, truthfully.
01:31So the company, a lot of founders, we're celebrating our nine-year anniversary today.
01:36And a lot of founders, thank you.
01:38Thanks.
01:39A lot of founders get tired of telling their founding story.
01:41I love it because I started the company very much inspired by my dad, who was a doctor.
01:48He saved my life.
01:49I have a congenital heart condition.
01:50I had a heart procedure when I was 18.
01:53And the main side effect of my heart medication after my heart procedure was erectile dysfunction.
01:58How old were you?
02:00I was about 18.
02:0018.
02:01Which is obviously every 18-year-old's dream to be a first semester in college and call up your dad
02:07and say, hey.
02:10But the really cool part is, actually, you know, when your dad is your doctor, yes, they care about your
02:15health.
02:15But they care about it in service of you living a happy and fulfilled life, right?
02:18In service of you achieving your health goals so you can achieve your life goals.
02:22We often talk about, you know, a sick person has many goals or has one goal and a healthy person
02:26has many.
02:27So the original inspiration, yes, we started with ED.
02:30But the hope was always to, and I'm sure a therapist would have a lot to say about this, but
02:34recreate my dad with software.
02:36Like, give him to everyone.
02:38So we started with men's health.
02:39We started with sexual health.
02:40Then we expanded to dermatology and fertility and cardiometabolic health.
02:44And then when we expanded beyond men's health, we went from Roman and we dropped the man and we became
02:49Ro.
02:50So Ro really touches the nerve right off the bat.
02:53I'm going to work in a lot of innuendos today.
02:55Yeah, yeah.
02:56And sales go from zero to a million in your first month.
03:01And you expand mental health, skin care, smoking cessation, hair loss.
03:08Were there any experiments that didn't work out?
03:11Yeah.
03:12Smoking cessation did not work out.
03:15Really?
03:15Yeah.
03:16You still offer it, don't you, or no?
03:17We do not.
03:18It did not work out.
03:19I think there's a few reasons.
03:22One is vaping seems like a far more effective way for a lot of people to come off combustible
03:28tobacco.
03:29And the second is the medication that was available.
03:31It's a very hard thing, but the medication that was available also wasn't that effective.
03:34Only about 28 to 30% of people were able to go off smoking.
03:38So a few different reasons.
03:39But that was something that we put a lot of time and energy to and didn't work out so well.
03:43But it taught us a lot.
03:44So in the life of Roe, you dropped the man from Roman to Roe.
03:50Yep.
03:51Investors have injected over a billion dollars to fuel this expansion.
03:56A couple of years ago, Roe was buying a lot of companies and kind of pushing in all these different
04:02directions and conditions.
04:05And then there did come layoffs, as a lot of companies did in that kind of post-pandemic high.
04:13And we saw a little bit of a reprioritizing on what works.
04:18Yeah.
04:18Kind of take me inside those decisions.
04:20How did you figure out what to prioritize and where to spend your time?
04:26Yeah.
04:27I mean, the thing that we always do is we look at, in terms of prioritization, we look at impact.
04:30And impact us is like the number of people we can help times the magnitude that we can help them
04:35with each intervention.
04:36Right?
04:36And so you've talked about GLP-1s.
04:38A lot of people refer to them as weight loss drugs.
04:40We advertise them in terms of people losing weight.
04:43But, you know, they were originally invented for type 2 diabetes.
04:47Yeah.
04:47Then they were FDA-approved for obesity and overweight.
04:49Then heart disease.
04:51Then liver disease and kidney disease and sleep apnea.
04:54And so what's interesting to me is people ask me now a lot.
04:57They'll say, like, are you just GLP-1s or just weight loss drugs?
05:00The first answer is no.
05:02But the second answer is it is the fastest growing part of our business.
05:06It's the largest part of our business.
05:07But I find, like, the just moniker now, like, as a chip on the company's shoulder.
05:12Because if I told people that we were doing any one of those individual things, they would say, like, that's
05:18amazing.
05:18If I was like, we're the leading provider of GLP-1s and the only thing people in the country and
05:22the only thing people knew is that they treated diabetes, they'd be, like, amazing.
05:26So I think it highlights a lot of stigma associated with weight loss.
05:29But these drugs do treat basically the leading causes of death in the U.S.
05:34And so I'm happy to just treat the leading causes of death in the U.S.
05:38So your dad circles back into this story, right?
05:43So around 2021, your father, you mentioned a physician, started taking a drug maybe most mainstream Americans hadn't heard of
05:54yet called Ozempic.
05:56What happened?
05:57What did you see happen with your dad?
05:59And how did that change your thinking about where to take Roe next?
06:01So we often talk a lot about at Roe that you need data to move the brain, you need a
06:06story to move the heart, and you need both to move a human.
06:09So we think about that when it comes to marketing, and we also think about that in terms of personal
06:13experience, whatever it may be, but what products to launch, how we tell stories.
06:19But I was looking at the data of our business, and a lot of people were coming in with erectile
06:27dysfunction, right?
06:28That's where we started.
06:29And the number one thing that they asked us to help them with was also challenges with obesity and overweight,
06:33and the natural sequelae with carrying excess weight, heart disease, things like that.
06:40So I had a lot of the data that said this could be an opportunity.
06:43But at the time, there weren't, as people know, like these were not well-known things, there weren't that many
06:47effective treatments that people were aware of.
06:49And then my dad, who has type 2 diabetes, he went on Ozempic, and he lost 50 pounds, and his
06:57entire life changed.
06:59I saw his relationship with my mom change. I saw his ability to keep up with my niece and nephew
07:04and his grandkids dramatically change.
07:07His biomarkers are, to this day, the best they've been since I've been alive.
07:14And the other incredibly powerful thing is he's a physician. He knew the science behind it, right?
07:19He knew it wasn't a matter of willpower and self-discipline and all the things that people normally associate with
07:23weight loss or obesity.
07:25And we don't have 15, you know, could go into it for hours.
07:29But the most amazing thing was I saw someone who intellectually knew that it wasn't a shortcut or cheating.
07:34But until he used the medication himself, he still carried a tremendous amount of guilt that he couldn't lose the
07:41weight for my mom, for myself,
07:44to be there for his family and friends and his grandkids.
07:48And I saw him, like I saw the guilt just waste away once he went on the medication.
07:53It was quite powerful to see, to have that interaction with him.
07:57It brought us both, candidly, it brought us both to tears.
07:59And so I saw that in my personal life and saw just, not just that it helped him lose weight,
08:04but really the blast radius of the impact that that has.
08:08And then I saw, you know, we've helped now millions of patients across the country.
08:12And you sort of, you have that story and then what that data could represent, right?
08:16So data to move the brain, story to move the heart.
08:18And so we ended up building an experience in 2021 into 2022.
08:23We beta tested it.
08:24And then obviously...
08:25Experience means...
08:26Our experience for GLP-1s, our row body membership that's high quality care surrounding GLP-1s.
08:32But he was the inspiration of it.
08:34We had the data from our member base, but I saw it up close and personal.
08:38And so that's really the catalyst of us looking into it.
08:40And so again, I think sometimes like you'd love for it to be some consulting exercise where you're sitting there
08:45and you're like, we looked at TAM and it was data.
08:47And like your prioritization does have to...
08:53And your intuition like does have to survive contact with reality, like what happens in that interaction.
08:59But data is not going to tell you what to do like MapQuest would or, you know, Google Maps.
09:05It's not a roadmap.
09:06But you take into account when thinking about what to prioritize.
09:09So you said today GLP-1 medications are the fastest growing part of your business.
09:15How much of Ro's business today comes from weight loss medications?
09:19It is the fastest growing part.
09:21And I would say it's recently crossed the barrier of being the majority of our business.
09:25The majority of the business.
09:27Okay.
09:27And would Ro still be growing without GLP-1s?
09:31Yes.
09:31Yes.
09:32Yes.
09:32Okay.
09:33So today, something like 29 million Americans.
09:39You'll fact check me if I get this wrong.
09:41Different people have different estimates.
09:42Based on this room, I mean some very few hands were up.
09:44Yeah.
09:44There was not one in 11.
09:46I'm cautiously, yeah, I'm skeptical.
09:48But that's okay.
09:48We've got more work to do to break down the stigma.
09:50The latest Gallup survey says about 11% of U.S. adults have taken GLP-1 drugs for weight
09:57loss.
09:57So in just two years, their use has nearly quadrupled.
10:01And as access has opened up, so has scrutiny.
10:06You had a secret shopper study published in JAMA earlier this year found GLP-1 drugs can
10:12be obtained online with little to no clinical oversight.
10:17And I'll share a personal story of mine.
10:21Your dad and I have something in common, in that I have also lost 40 pounds this year
10:27on a GLP-1.
10:28That's amazing.
10:31Oh my god, stop.
10:33And I'll tell you, I was in my primary care physician's office just last week.
10:39And I see her about every eight weeks for check-ins about my side effects and now trying to slow
10:45my weight loss, which, as anyone who's ever dealt with obesity knows, like a good problem
10:50to have.
10:51And I said to her, you know, I'm sitting down on stage next week with the CEO of Roe.
10:58What do you think?
10:59And she kind of had like a groan for me.
11:02Yeah.
11:03And she said that, you know, I have seen this drug perform miracles for people and I really
11:12feel, I relate to your dad in the way that it has improved not just his physical being,
11:18but his mental health.
11:19And she says, I see the power of these drugs and I also have seen patients come sit on my
11:25exam table for their annual physical and they're down maybe 20 pounds from a year ago.
11:32And I say, hey, what's going on?
11:33And they say, well, I've gotten a GLP-1 online.
11:37And I think it worried her that some people are on this journey and not having those, you
11:45know, those human touch points with a provider.
11:49So, you know, your mission is opening access to healthcare, making healthcare more accessible.
11:56But I want to hear about kind of the limits of that.
11:59Is there such a thing as making GLP-1s too easy to access and how do you design against
12:06that?
12:07Yeah, it's a great question.
12:08First, thank you for sharing that because it does take a lot of courage to, I think,
12:10share your health journey with people.
12:13And congrats.
12:14That's awesome to hear.
12:15Your doctor sounds really great.
12:18Genuinely.
12:18I think there's a lot, there's a big conversation right now, particularly with AI, where people
12:24will say things like healthcare must remain human.
12:28And I think we need to hold like two things to be true because I actually think that that
12:33phrasing, but that lens misses the ultimate objective, which is outcomes for patients.
12:39And so I think that the conversation right now is prioritizing a lot of inputs over outcomes.
12:45And I think we have like a moral obligation as a society to really prioritize outcomes
12:48over inputs.
12:50Right?
12:50So to me, what people should look at, and I think the new thing as in Roe, should always
12:56have a higher burden of proof.
12:58Right?
12:58So we should bring data, we publish data that our outcomes match those of phase three
13:04clinical trials in real world evidence.
13:06We should talk about the experience we provide, which I think, you know, we do monthly check-ins
13:09with patients.
13:10And unlike, I would say, an in-person provider, like we use actually AI and we publish research
13:15on this as an example to, when anyone sends a message to a provider on Roe, gets routed
13:21through an LLM, we classify the topic, the issue, and we can actually identify if there's
13:26a side effect.
13:26If there is, it is structured, a task is created, it's assigned to a healthcare provider,
13:31and our median response time to a side effect 24-7 is sub 30 minutes.
13:35That's not concierge care online, that's an entirely new form of healthcare.
13:40And I understand why the new thing will always have a higher burden, but I also don't think
13:46we should give the status quo a pass just because it's the status quo.
13:49So our healthcare system, and I understand where your doctor is coming from, but a lot
13:54of people, like a third of Americans don't have a PCP, and I think that our healthcare system,
13:59the status quo is like dramatically over romanticized.
14:04A hundred million people are in some form of medical debt, it's a leading cause of individual
14:08bankruptcy in the US.
14:09Right?
14:10That's a pretty like horrific thing.
14:12Yeah.
14:13And so to me, my biggest worry is actually that we talk a lot about the inputs over outcomes,
14:18and I think a good analogy, if I can, is driverless cars.
14:21Sure.
14:22So very, very briefly here, but I think it's important because I hope that you'll recognize
14:26this when people talk about driverless cars and then take it to healthcare, which is about
14:2940,000 people every year die from car accidents, 40,000.
14:34And about 43,000 people a year die from breast cancer.
14:39And when it comes to driverless cars and autonomous vehicles, in certain pockets we have a lot of
14:45proof that they are 10 to 20 times safer, but we are not rolling them out.
14:50Right?
14:50So we have a cure for cancer for certain patients that have this cancer, and we just don't roll
14:54it out.
14:54And the reason that we don't is we talk a lot about jobs, and it's not to diminish those
15:00jobs, but we are choosing in that instance, we are choosing, I think, jobs over lives in
15:05certain pockets.
15:05Now, I do think it's incumbent on Waymo and other autonomous vehicle companies to prove
15:11that they are much safer, but once they have proven that, which they have in pockets,
15:15we as a society, I think, should try to roll those things out as quickly as possible.
15:19I think if they had found a cure for a specific type of cancer, we would not be having the
15:23same
15:23type of conversation.
15:24I think with AI and with healthcare, we will get to the point where we are going to have
15:28very similar levels of friction.
15:31And so I think your question is like, when you ask at the tail end to get at your direct
15:36question, which is, is it too easy to get?
15:39I would say no treatment should ever be, or the idea to me, it should be as easy as possible
15:47for the right people to get treated.
15:49Yeah.
15:50Right?
15:50And I think the phrase too easy is not the right framing.
15:54It's actually who.
15:56And then for who, easy as humanly possible, right?
15:59Once someone.
15:59And I think when we talk about GLP-1s, you need to do it in a safe way, not just
16:03initial
16:03access, but in an ongoing basis.
16:05Yeah.
16:05But if you just run the math, which I think is important to do, like these drugs are approved
16:09for people who have overweight, obesity, diabetes, liver disease, sleep apnea, heart disease,
16:14kidney disease.
16:14It's being studied for neurodegeneration, pain management, skin, autoimmune, whatever it
16:19may be.
16:2075% of the US population has overweight or has obesity.
16:23And then that's just bottoms up.
16:24And then tops down, like if 100 people, there's probably 12% of the population that's
16:29quote unquote metabolically healthy.
16:30So like the idea that someone is not clinically eligible for this is totally possible, but it
16:36is the like minority of humans in the US.
16:39Yeah.
16:40And so, you know, I think again, I think that that's, we're at 10% and I think there's
16:46a long way to go.
16:47Well, I'll throw you a bone that I did ask my PCP a question through the online portal
16:51on Monday and I still have not heard back from her.
16:54Perfect example.
16:56Ro has...
16:57She's very busy.
16:58I'm sure she is.
16:59And it's, but the thing...
17:00No, we don't have time.
17:01Okay, great.
17:03I like that.
17:03That's good.
17:04You've enlisted some pretty big names to help bring Ro to the masses this year to help
17:11sell these medications.
17:12Serena Williams starred The Go in Ro's first Super Bowl ad earlier this year.
17:18NBA Hall of Famer Charles Barkley says he's down 100 pounds after using Ro.
17:23Daddy's on Ro.
17:24That's right.
17:25Actors Christy Metz.
17:26And I find this particularly interesting, the big push into kind of celebrity advertising,
17:31because I think we've seen a lot of celebrity ads make people angry over the last couple
17:38of years.
17:38Our sister site Morning Brew has a good name for this scandal as marketing.
17:44Like, just ask Sydney Sweeney, who's been nearly canceled twice in the last two years,
17:48for some spicy ads.
17:52And then here comes Ro putting Megan Fox in a skin-tight red catsuit as the human embodiment,
18:00beautiful, of the erectile dysfunction pill.
18:05Take me into the conference room where someone is bringing you this campaign pitch.
18:10And is anyone going like, are we sure about this?
18:16Well, I think in an initial brainstorm, we've got to be in divergent mode.
18:19So that's always a yes and situation.
18:21Sure.
18:21You don't want to clamp down on great ideas.
18:25I think all of them were very, very intentional and deliberate in why we chose them and why
18:30they chose us.
18:31And each partner has been incredible.
18:32But they're telling, each one of them is telling a different story.
18:35And they're all actually trying to create a permission structure for a different group of
18:41people to feel more comfortable seeking out healthcare.
18:43They are trying to break down that stigma in a different way.
18:46And so whether it's Megan or Charles, I mean, take Serena, who I think very, took a lot of
18:52courage, but she was trying to bust a very specific myth.
18:55Yeah.
18:56Right?
18:56Which is that she is one of one in her professional life.
19:00And she's probably someone, it's very difficult for anyone to argue that she doesn't have
19:05willpower and self-discipline.
19:07Right?
19:08And so there's this concept around GLP-1s being a shortcut.
19:11And I think no one sort of combats that myth more so than her.
19:16So she was one of one in her professional life.
19:18But the story that she told was actually one of millions.
19:23It was a mom of two who, after having kids, had trouble on the scale, was doing everything
19:28right, was eating right, was exercising.
19:31She had unlimited resources to access support.
19:34And so I think I've spoken to patients who have been at tears after seeing Serena's campaign
19:39because they said something to the effect of even if Serena needs this, then I feel comfortable
19:46seeking out healthcare.
19:47Zach, I want to cut you off because we've got only a couple minutes left.
19:50That's fine.
19:50Before we wrap, I want to talk about kind of how Ro keeps up the momentum.
19:56You, Ro announced today in Business Insider, read all about it, a new AI agent, Robin,
20:03that acts as a personal healthcare concierge.
20:06You can talk to Rob, patients can talk to Robin.
20:10Robin sees your health records and can even take steps to act on your behalf,
20:16kind of liaisoning between you and your provider.
20:20Every company seems to want to build an AI assistant right now.
20:22Why did Ro need one?
20:25Two big, I think, improvements that Robin delivers.
20:27The first is, if people use, like I use ChatGPT Health.
20:31It's great.
20:31The challenge is, first of all, like using it takes a lot of work.
20:35You have to give it a tremendous amount of context, right?
20:37So you go and you talk to your doctor.
20:39Let's say you had that doctor's visit.
20:40And then if you want to talk to Chat about it or Claude or whatever, you have to then port
20:44all of that conversation.
20:45You have to be great at remembering that conversation and typing it all out or using another device and recording
20:49it and sharing it.
20:50So you have to create that context, update it with every new drug you're taking, dose, X, Y, or Z.
20:54So you are basically playing a game of telephone.
20:57And then you have to have like a PhD in prompting to really get the most out of it.
21:00So one is context and the second is action.
21:02You go and talk to ChatGPT and let's say you did all that work.
21:06And then at the end it's going to say, great, here's all this education or insight, now go talk to
21:10your doctor.
21:10What Roe is able to do is the very act of your seeking out healthcare creates context for the agent
21:17automatically.
21:18When you are talking to your doctor, when you are reporting a side effect, when you are logging your weight
21:21or an injection
21:22or reporting a side effect or getting a lab test that they might have already ordered, all of that is
21:27already structured for the agent.
21:29So you are having incredible conversations with it with very little friction.
21:34Then when it says, instead of saying, go talk to your doctor somewhere else, it says, would you like to
21:39talk to your doctor?
21:40Here's a summary of our conversation, press a button and it can actually cascade care.
21:44So it starts to close that insight to intervention loop for patients.
21:48Yeah.
21:48I mean, when you have, when you're managing more of your patients' healthcare and their data on your app, I
21:55think it can be tempting to keep them there.
21:58But are you, do you see this technology also prompting people to like go meet in person with your provider?
22:06Yeah.
22:07I think there, there are so many things.
22:08Again, we are a compliment to someone's care.
22:11But I think the nice part when you talk about data, like they're currently giving it to their doctor.
22:15The nice part is that they don't have to repeat themselves when they want to talk to AI.
22:19Yeah.
22:20All right.
22:21Well, we're at time, but I, I did want to know, you shared openly that you were patient number one.
22:27Are you still a Roe user?
22:29And please don't sue me for asking.
22:30Yeah.
22:30I would never.
22:32I'm on like half our products, but yes, I'm on.
22:35You're getting high on your own supply.
22:37No, I wouldn't say high.
22:38I would say I'm achieving my health goals using our products.
22:42Yes, very much so.
22:43Well, I imagine that maybe in the perimeter of this building, you might get some traffic hits on Roe.com.
22:49Roe.co.
22:50It rhymes.
22:51It's very easy.
22:51Well, I'm glad it's not Roe.ai.
22:53Not yet.
22:55But thank you so much, Z, for being here.
22:57Round of applause for Z.
22:58Yeah.