#204 – Concierge medicine takes a personalized, preventive approach | Chloe Harrouche & Mike Haney

Concierge medicine can help personalize healthcare and disrupt the traditional primary care model. Traditional primary care isn’t positioned to handle the frequent check ins and actionable steps that empower patients to optimize their health and wellness. Chloe Harrouche and Mike Haney discuss The Lanby, which Harrouche co-founded. The Lanby’s primary care membership provides patients with a three-person, non-siloed care team and weekly touchpoints regarding wellness, so patients can track their progress and make necessary tweaks.

Helpful links

The Lanby: https://www.thelanby.com/

Chloe Harrouche on Instagram: https://www.instagram.com/chloeharrouche/

Chloe Harrouche on Twitter: https://twitter.com/HarroucheChloe

The Lanby on Instagram: https://www.instagram.com/the.lanby/

The Lanby on Twitter: https://twitter.com/TheLanby

2:03 – Concierge medicine can ease the patient burden of healthcare

Chloe Harrouche co-founded The Lanby, a primary care membership service that delivers a three-pronged care team approach to streamline preventive medicine for patients.

The Lanby is a wellness forward primary care membership. We like to take an integrative, proactive approach to your health. And so at the core of our model is a three-person care team. So all of our members get assigned three people as opposed to just a physician. So they’re working with an MD, an RD, who we call their wellness advisor. They actually do more than talk to patients about nutrition. They also look at your sleep, your mental health, your glucose levels, other wearable data. They’re really trying to help you optimize from all different wellness modalities. And then thirdly, you have a concierge manager who works to sort of be the quarterback across all the different streams of your healthcare. They  serve as a patient advocate. They also are the ones that you can reach out to at any time via text or email. So really trying to help streamline your care and just make it feel like less work.

3:52 — The traditional primary care model doesn’t help patients optimize their health

Traditional primary care models don’t incorporate the time or expertise required to help a patient navigate their ongoing wellness.

Primary care, which is designed to be that more general specialty in healthcare and is meant to sort of tap into all of the different angles of your health, shouldn’t just be seen from one lens. And so I wanted to think about it in terms of how could I introduce all of the skills necessary in order for primary care to be that more holistic view of your health. I also thought about it from the perspective of my own journey where I was a 23-year-old breast cancer survivor. I was very interested in wellness. I wanted to go to my doctor for that guidance because I didn’t trust myself to do the research online. And, you know, no one should really—it becomes a very dangerous rabbit hole. So when I found what my doctors were ill-equipped to talk to me about, I thought to myself, “Well, who should they surround themselves with in order for it to be more of a dialogue where the doctor is still part of the conversation but they’re not necessarily the expert at the table?”

13:28 — Self-care and wellness approaches to health empower patients

Illness, whether a cancer diagnosis or a chronic disease can leave a patient feeling like they have a lack of control. Taking charge of the factors in one’s control regarding wellness helps people reclaim their power over their health.

I think coming out of treatment, which is very much like things happening to you, I wanted to be the one in the driver’s seat. I craved that feeling of control. And when you control your diet, when you control whether or not you exercise, when you control when you eat and when you don’t eat, it gives you that sort of satisfaction that you got to be the one to control. And so it makes you feel like you are the one that’s preventing cancer manifesting itself inside of you. And so that’s just a very rewarding feeling.

14:42 — The siloed model of healthcare isn’t working

Having doctors with specialties is important, but a specialist in one area often does not consider the patient as a whole or the patient’s long-term health goals. This siloed approach lacks coordination and cohesiveness. Yet patients need guidance and expertise that doesn’t involve wading through so much conflicting information online.

That’s where I struggled with, I can’t just talk to a gynecologist, because they don’t understand my cancer history, and I can’t just talk to an oncologist, because they don’t understand my reproductive goals. And what are my goals? That’s a personal decision. But I do need to have the right sounding board who understands the science approach to be able to make sure that my efforts are actually based in real science.

15:47 — Seeing a primary care physician annually isn’t enough

An annual checkup with a primary care physician doesn’t provide insight into what wellness modalities are working for a patient. More frequent health monitoring, with labs and other data, help people assess incremental progress and learn where further change is needed.

I think it’s excellent for people to be pushing themselves to try new things and see how that impacts their overall health. But you can’t just base it off of how you feel. So I think it’s important for people to have that relationship with a doctor where they can go in for blood work every three to four months to see, “Okay, I’ve been intermittent fasting for three months. How has that changed my fasting glucose? Or how has that changed my body fat? Or how has that changed anything?” Also making sure that you’re looking at your thyroid and your hormone levels and saying, “Okay, I understand that it’s maybe helping my body fat, but are my thyroid and my hormone levels still… And so that’s where I think it’s important to not just operate in a vacuum, but really think about your health from a whole-person perspective.

19:07 — Traditional primary care approaches often operate like a revolving door

Harrouche discusses how concierge medicine empowers patients throughout their health and wellness journey, which is in sharp contrast to the traditional primary care model of short, infrequent visits or touchpoints.

They come to us because they’re very motivated to take their health in their own hands, whether that be more routine blood work, whether it be changing their diet, changing their exercise regimen, tracking the impact of food on their glucose levels, seeing how they can bring down those glucose levels over time, and repeating that cycle on a frequent basis to make sure that you’re staying on target. Prioritizing what your wellness goals should be based on what your lab work says. All these things are important for a primary care doctor to do, but again, the way that our current model is structured, primary care doctors are not incentivized to do that with you. Why? Because they just want to get you out the door.

22:16  — To optimize their health, patients need more frequent check-ins

Harrouche explains The Lanby model of having a wellness advisor who reviews a patient’s data weekly and then offers optimization suggestions.

It’s helpful to have a doctor who understands your medical history, who understands your family history, who understands your lifestyle, what you’re eating, how you’re eating, etc., to be able to provide suggestions as to how to work around improving these lab values. So I think that’s where it’s really important. And then that’s also where the wellness advisor comes in. So for example, CGM data. The doctor is actually not the one on our team who reviews the CGM data; our wellness advisor is. And so she works with our members on a weekly basis to say, “OK, this is what your baseline levels look like. Based on what you’re eating, how you’re exercising, how you’re sleeping, let’s change this this week and let’s see how that affects your levels.” And, and then they meet again the following week. And so they’re constantly iterating their lifestyle to be able to maximize their value ranges, or not maximize, but optimize rather.

32:07 — The traditional healthcare model works in reverse

Healthcare currently operates with a diagnose-and-treat approach, rather than focusing on prevention or follow-up. Concierge medicine can help patients feel more accountable and tapped into their health and wellness.

The thing to remember is that we focus on preventive care, which means that the doctor, as you know, someone trained in the traditional medical system, is very good when it comes to diagnosing, very good when it comes to understanding the root causes, but not necessarily the one that’s going to be the person keeping you accountable. And so that’s where we’ve sort of shifted the molds of primary care to be less focused on the doctor and more focused on that follow up. So our wellness advisor and our concierge manager work together very collaboratively. Of course, the doctor is always part of the conversation.

36:38 — Technology aids the ongoing monitoring of biomarkers and other health metrics

Whether it’s a continuous glucose monitor or another wearable or device, technology helps track health progress.

Being able to use a device like Levels allows us to provide the data that people need in order to really see how their body and their constitution corresponds to things that others might correspond differently to or react differently too. So that’s a great tool for us. We also recently got an InBody composition analysis machine, which allows us to measure the ratio of your visceral fat and your lean muscle mass, which is again helpful to allow us to have another data point to measure progress. So it’s really always about using these tools to track and measure progress over time. The third one that I’ve always been really excited about is New Amsterdam Genomics. They are a genomics company. It’s pretty pricey, but you only have to do it once.

42:49 — Wellness approaches don’t have to be all or nothing

Small and simple tactics can help improve health and wellness; tactics don’t have to be extreme or overwhelming to have a benefit.

I think there’s still a huge learning curve when it comes to wellness, and I think a lot of people feel like it’s binary. Like either you’re obsessed with your health, or you just don’t have the time or don’t have the motivation—and you can’t be in between. And I think that little things like making sure that you walk for five minutes after a meal, those are such easy, low-hanging types of tactics that everyone should implement. And again, you don’t need a membership at The Lanby to do that. You don’t need to use Levels to do that. But it’s just being able to help that movement, that education around the little things that you can do to be just a little bit more conscious and aware—I think will make a huge difference in saving our healthcare system.

Chloe Harrouche (00:06):

Coming out of treatment, which is very much like things happening to you, I wanted to be the one in the driver’s seat and I craved that feeling of control. When you control your diet, when you control whether or not you exercise, when you control, when you eat, and when you don’t eat, it gives you that satisfaction that you got to be the one to control. It makes you feel like you are the one that’s preventing cancer from manifesting itself inside of you. That’s just a very rewarding feeling. I felt better cutting out sugar and carbs and alcohol than I did taking tamoxifen.

Ben Grynol (00:52):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. Along the way, we have conversations with thought leaders about research-backed information so you can take your health into your own hands. This is a whole new level.

Mike Haney (01:21):

I’m Mike Haney, part of the editorial team here at Levels. Today, I got to sit down and chat with Chloe Harrouche. Chloe is the co-founder of a company called The Lanby, which is a concierge medical service in New York. The Lanby is really interesting in that it’s trying a few unique things in that space of more personalized medicine. They get at one of the things I’m obsessed with, which is how do these types of businesses scale? How do we get to the point where everybody can have a better experience with a doctor, not just people who can go to one of the new concierge services? That’s something that Chloe and her team are thinking a lot about.

(01:54):

Chloe also had a really interesting personal journey to this, being diagnosed with cancer at 23, and that informed a lot of how she thought about her own health and how she thought about the experience of being what she calls a professional patient. This is a really fun and wide-ranging conversation with somebody who’s got a really unique perspective on healthcare in general. Here’s me and Chloe. I know there’s a lot for us to talk about in doing a little background research on you. Just knowing what I know about The Lanby, we interviewed a couple of your colleagues last year, I think it was, and we do have an article out on our site that’s the interview with them about The Lanby.

(02:34):

But maybe just for folks listening, that’s a good place to start. Why don’t you just tell us a little bit about what The Lanby is and then maybe we’ll go backward and talk more about the founding and some of your journey?

Chloe Harrouche (02:44):

Yeah, sounds good. The Lanby is a wellness forward primary care membership. We like to take an integrative proactive approach to your health. At the core of our model is a three person care team. All of our members get assigned to three people as opposed to just a physician. They’re working with an MD, an RD, who we call their wellness advisor. They actually do more than just talk to patients about nutrition. They also look at your sleep, your mental health, your glucose levels, either wearable data. They’re really trying to help you optimize from all different wellness modalities.

(03:20):

And then thirdly, you have a concierge manager who works to be the quarterback across all the different streams of your healthcare. They serve as a patient advocate. They also are the ones that you can reach out to at any time via text or email. Really trying to help streamline your care and just make it feel like less work.

Mike Haney (03:41):

How did you arrive at the three person team model?

Chloe Harrouche (03:45):

I had always been inspired by a model that I saw firsthand when I used to work at this nonprofit organization called myFace. They work with children that are born with craniofacial conditions. I loved the way that every Monday morning they would do a collaborative rounding where all of these different specialists would come together and look at patient charts and understand what each other’s perspectives were around how to treat that patient from a very collaborative approach. I felt that when it came to healthcare, it’s becoming increasingly more difficult and more apparent for specialists to be operating within a vacuum or within a silo.

(04:35):

Primary care, which is designed to be that more generalist specialty in healthcare and is meant to tap into all of the different angles of your health, shouldn’t just be seen from one lens. I wanted to think about it in terms of how could I introduce all of the skills necessary in order for primary care to be that more holistic view of your health. I also thought about it from the perspective of my own journey where I was a 23-year-old breast cancer survivor. I was very interested in wellness. I wanted to go to my doctor for that guidance because I didn’t trust myself to do the research online. No one should really.

(05:20):

It becomes a very dangerous rabbit hole. When I found that my doctors were ill-equipped to talk to me about wellness, I thought to myself, well, who should they surround themselves with in order for it to be more of a dialogue where the doctor is still part of the conversation, but they’re not necessarily the expert at the table? It’s also unrealistic for us to assume that doctors will have that training. I mean, I know that now today you see more doctors going into functional and integrative medicine, which is amazing, but the speed at which we would need all doctors to transition to that type of care, it just doesn’t align with the demand.

(05:57):

Our model cuts through that and pairs doctors with wellness advisors so they’re able to incorporate that philosophy, that more proactive wellness-based approach into the conversation without having to force themselves through an additional certification, which again, most doctors don’t have the bandwidth to take on.

Mike Haney (06:17):

I love that. One of my obsessions as I’ve learned more about functional care and spoke with both functional med doctors and folks that run clinics like yours is this question of scalability and how you solve some of the pragmatic issues that come along with this more integrative approach. I really like that idea of recognizing the limits of what a doctor… Particularly all the doctors that are out there today, right? It’s one thing if we’re talking about 10 years in the future and what can we start doing in med schools and with kids today, et cetera, and generationally we can change it, but there’s an enormous medical industry out there today.

(06:52):

I like that idea of just add on a person who can only focus on that, can be the partner to the doctor. I think that’s a really interesting approach. I want to come back to some of those pragmatic questions about The Lanby and the functional stuff. But since you mentioned it, I’d love to hear more about your medical journey. I know reading both your experience in your early 20s with breast cancer and then also pregnancy I think was another, based on an essay I read I think in Elle, was another journey for you. If you don’t mind, maybe just share a little bit about those journeys and what they informed for you in terms of being what I read you call yourself a professional patient.

Chloe Harrouche (07:34):

Yes. I pride myself on that. As you read, I was diagnosed with breast cancer when I was 23 years old. I had no family history, so this really came out of the blue for me. My treatment was pretty straightforward. Thank God. I had a double mastectomy. I had chemotherapy for three months, and I had radiation, and then I started taking tamoxifen. I just followed the standard of care protocol. As a patient, as you pointed out, I loved the idea of being the best patient. I have a very competitive nature, and so I wanted my doctors to love me. I think that part of that was rooted in the fear that doctors only spend time with the patients that they like.

(08:24):

And that’s probably somewhat true, hopefully it’s not very true, but I knew that they would go the extra mile for me in ways that they wouldn’t for most of their patients because they liked me. I always came prepared. I always said yes. I was always down for anything. And that was great for the course of my treatment. And then as I graduated from that stage and I transitioned into survivorship mode, I started asking my doctors questions about wellness. I was very interested in being more proactive and taking more ownership and control over my health, and wellness is really the best way or the only way really to do that.

(09:06):

I wanted to eat right. I wanted to exercise as much as I need to. I wanted to take all the supplements. I was willing to do whatever it took. But when I would go to my doctors and I would ask them, “So tell me what to do,” they didn’t know what to tell me. That was the first sign of, okay, here’s where I’m hitting a wall. And that’s when I started googling, listening to podcasts, reading everything that I could in order to educate myself on wellness. What should I eat? What should I not eat? What I found was that when I met with dieticians, they were very old school in how they thought about nutrition.

(09:43):

Dairy, meat, soy were all out of the question. If you read more recent literature and research, it says that’s actually not true. We can be eating those things. If anything, like soy, there are some benefits to eating soy if you have breast cancer, same with meat as long as you’re eating pastured raised and grass-fed. I dismissed the idea of working with a clinical registered dietician and instead wanted to get more of the cutting edge research when it came to wellness. I started intermittent fasting. I started being incredibly extreme about what I ate. I cut out all carbs. I cut out all sugar. I tracked everything that I could.

(10:30):

I obviously took it to a level that was probably miserable for everyone around me. I didn’t really feel it so much, but my body did for sure. And that’s when I started noticing my body was shutting down in ways that I wasn’t expecting. I lost my period. I was very underweight. I was obviously in denial about these things, because to me, I started to associate being thin and minimizing body fat, whatever you want to call it, with health. I think in a lot of ways that’s true. I think for women it’s definitely not. Obviously you need muscle mass, you need your body to recognize that it’s in a healthy state in order to build muscle to operate effectively.

(11:22):

I clearly wasn’t in that state. I met with a number of doctors who told me I didn’t need to gain weight in order to get pregnant. Obviously these are reproductive endocrinologists who are incentivized to tell you that they can fix you with pumping you with hormones. It didn’t work. I did get pregnant, but they didn’t survive past week seven. Ultimately, I decided, you know what? I need to just reset my expectations and I need to change my perception of what health is. I still am in that process. Actually, I don’t even know what the answer is. All I know is that I can’t just Google it. I really do need a care team that is integrative, that understands my personal goals, that understands that it’s not one size fits all.

(12:13):

Not every breast cancer survivor should follow the same protocol when it comes to their survivorship and their long-term health. That’s where I’m at.

Mike Haney (12:23):

It’s such an interesting point about the individuality of this. To me, that feels like one of the real benefits of this integrative functional approach is just that recognition. Again, it gets back to foundational systemic things of the way our healthcare is system set up is not to deal with that idea. It’s all set up on here’s the treatment plan, here’s what we do, go off and get healthy. Your journey’s so interesting having been through that cancer experience early and, A, having to confront such a serious health issue so early in your life, and then going through what you described as a standard protocol treatment.

(13:03):

It’s not like you were healed by some ceremony out in the desert or smelling the right herbs. You went through a very standard medical procedure, and then still found your way to the wellness perspective on it. I’m curious what initially led you to that wellness approach as you started to get past the initial cancer treatment and, as you say, go into survivorship mode.

(13:28):

And then also what brought you out of it. Because when you talk about going extreme on the health stuff, we see this all the time in folks and it’s something we think a lot about in terms of how we promote some of our suggested approaches to health is how much this stuff can become part of your identity and that that can really start to cut off that flexibility, that learning, that curiosity that might have brought you to this approach in the first place.

(13:53):

It’s easy to become very dogmatic when you go, well, I’m the person who does low carb. I’m the person who has this body fat. I’d love to hear about your journey into it and then this new journey not out of it, but recognizing like, hmm, maybe I do need some different approaches here.

Chloe Harrouche (14:08):

Yeah, great question. I think coming out of treatment, which is very much things happening to you, I wanted to be the one in the driver’s seat, and I craved that feeling of control. When you control your diet, when you control whether or not you exercise, when you control when you eat and when you don’t eat, it gives you that satisfaction that you got to be the one to control. It makes you feel like you are the one that’s preventing cancer from manifesting itself inside of you. That’s just a very rewarding feeling. I felt better cutting out sugar and carbs and alcohol than I did taking tamoxifen. And if anything, I self-treat in a lot of ways, which is not recommended.

(15:00):

But there was a period of time where when I lost my period, I was like, this is actually amazing. I am not producing any estrogen. My tumor was estrogen receptor positive, which means that I’ve stopped it from growing just by being underweight. I don’t know if that’s necessarily the right goal when it comes to fertility. But if I’m only focused on cancer recurrence, then maybe that is the right goal for me. That’s where I struggled with I can’t just talk to a gynecologist because they don’t understand my cancer history, and I can’t just talk to an oncologist because they don’t understand my reproductive goals.

(15:39):

Again, what are my goals? That’s a personal decision, but I do need to have the right sounding board who understands the science approach to be able to make sure that my efforts are actually based in real science. I am a bioengineer, by the way, so I do have some understanding of medicine and science, but definitely no degree as an MD. Anyway, with that said, I think what I learned though is that I should have tracked this. I should have been more consistent about getting my labs done more regularly when testing and experimenting with all of these different wellness modalities.

(16:19):

I think it’s excellent for people to be pushing themselves to try new things and see how that impacts their overall health, but you can’t just base it off of how you feel. I think it’s important for people to have that relationship with a doctor where they can go in for blood work every three to four months to see, okay, I’ve been intermittent fasting for three months. How has that changed my fasting glucose? Or how has that changed my body fat? Or how has that changed anything?

(16:45):

Also, making sure that you’re looking at your thyroid and your hormone levels and saying, okay, I understand that it’s maybe helping my body fat, but are my thyroid and my hormone levels still optimal? That’s where I think it’s important to not just operate in a vacuum, but really think about your health from a whole person perspective.

Mike Haney (17:05):

One thing I’m curious about when you talked about that point of your oncologist doesn’t necessarily know what you’re going through on the fertility side and your fertility doctor doesn’t necessarily know what to do about your cancer history, it made me think about something I read on The Lanby site, the idea that 80% of your healthcare needs can be solved by primary care. I was thinking about the fact that it’s not how I think of my primary care physician today. We were just looking for a new pediatrician for my son and doing the scanning through Aetna’s listings and trying to make some evaluation based on, I don’t know, whatever, vibe, who can get us in.

(17:44):

I think that the relationship with primary care, particularly in a traditional insurance model, is very transactional. But it feels like what you’re talking about is addressing that siloed approach and centering a more holistic or integrative approach within the primary care model. Maybe just talk a little bit about how we need to rethink what we call primary care and what its role is.

Chloe Harrouche (18:12):

Yep. You’ve just described the mission of The Lanby. It’s totally rebrand primary care because it really deserves one. Where primary care has evolved to is being that transactional, reactionary, almost urgent care. As opposed to using it to address your deficiencies and through that lens identify what your goals should be, just finding that partner in optimizing your health, it’s become a very useless resource for people. The Lanby’s goal is to be a quarterback. For me in particular, I needed someone to coordinate my care across all the different specialists that were involved in both my treatment and my survivorship.

(19:01):

Because again, what is considered standard of care, no one’s really going to opine on. But when it comes to the aftermath, that’s when things started to get a little bit gray. Having a generalist be the person who is understanding what’s going on, understands your constitution, your history, your family history, and your long-term goals is important in piecing together all that information and helping you make an educated decision as to what to do next. I think that’s the first thing in terms of coordination of care. And then when it comes to the rest, we have a lot of patients who say, “I’m pretty healthy, but I want more. I don’t want to just be normal. I want to be my best.”

(19:50):

They come to us because they’re very motivated to take their health in their own hands, whether that be more routine blood work, whether it be changing their diet, changing their exercise regimen, tracking the impact of food on their glucose levels, seeing how they can bring down those glucose levels over time, and repeating that cycle on a frequent basis to make sure that you’re staying on target, prioritizing what your wellness goals should be based on what your lab work says. All these things are important for a primary care doctor to do. But again, the way that our current model is structured, primary care doctors are not incentivized to do that with you. Why?

(20:36):

Because they just want to get you out the door. They’re volumes based. They’re fee-for-service based. They don’t really care about the quality of care that they’re providing. They just care about trying to drive up the number of patients that they’re seeing. It’s a mismatch of expectations between patients and providers, and that’s what The Lanby has set out to redefine.

Mike Haney (21:01):

One of the things you mentioned in there is the point about data, getting labs more often, and even in your own journey, talking about tracking more when you’re doing these experiments through the data that you’re seeing, whether that’s labs or wearables or whatever, how it’s working for you. How do you think about an individual being responsible for or having some capability to understand their data themselves and where that relationship with the primary care physician in this kind of a model where you have a PCP who’s willing to look at the labs you ordered from somebody else or willing to look at your CGM data.

(21:36):

How much can individuals do with that and understand it versus how much do you really need somebody who’s on the PCP side to help you make sense of those markers?

Chloe Harrouche (21:48):

We actually equip all of our members with a lab guide. When we send them their lab results, we also send them our grading scale of how we evaluate all these different labs, what’s considered normal, but what’s also considered optimal ranges, what these different lab results mean, so that when you’re looking at your results, you have as much information as possible to educate yourself. But there is obviously a line, right? While we do try to empower our members to have a seat at the table, it’s important when there are abnormal markers for us to be able to help educate you on why that might be the case, what it might be indicative of beyond what you can read on Google.

(22:33):

Because a lot of times there’s a root cause behind that as a symptom. We try to help piece together all these different pieces of information that come from not just your lab results, but also what you shared in your intake, potentially family history or a genetic mutation that, again, would not be in the lab results. It’s hard for the patient to know that that would be the cause of it. It’s helpful to have a doctor who understands your medical history, who understands your family history, who understands your lifestyle, what you’re eating, how you’re eating, et cetera, to be able to provide suggestions as to how to work around improving these lab values.

(23:16):

I think that’s where it’s really important. And then that’s also where the wellness advisor comes in. For example, CGM data, the doctor is actually not the one on our team who reviews the CGM data, our wellness advisor is. She works with our members on a weekly basis to say, “Okay, this is what your baseline levels look like based on what you’re eating, how you’re exercising, how you’re sleeping. Let’s change this week and let’s see how that affects your levels.” And then they meet again the following week.

(23:43):

They’re constantly iterating their lifestyle to be able to maximize their value ranges, or not maximize, but optimize rather. That’s where the wellness advisor can really add a lot of value for patients and use data to be more personalized in her guidance.

Mike Haney (24:00):

I’d love to walk through your professional journey to The Lanby. Like you said, you’re not an MD. You started I think in consulting, and then went through some nonprofits. Maybe just talk about how you professionally ended up founding The Lanby.

Chloe Harrouche (24:15):

In undergrad, I studied bioengineering. I loved science, I loved math, I loved medicine, and so bioengineering was a natural fit. I went to UPenn. I was valedictorian of my class. But ultimately, I decided that I wanted a broader education when it came to healthcare. That’s what brought me to consulting. I worked at Deloitte for a few years in their technology division. They trained me in Epic, which is the leading electronic health record system. I worked with large hospitals to be able to implement Epic into their workflows.

(24:54):

Through that perspective, I was able to understand what the pain points are from a provider point of view, what’s stopping them from being more innovative, more efficient in their operations, et cetera. I think that was a great first introduction into healthcare. But then I wanted, especially post-breast cancer, I wanted a position that would allow me to be more on the frontlines. That’s when I transitioned into a nonprofit where I worked as a director of development and fundraising to support this organization called myFace. What they do, as I mentioned briefly before, is they support children who are born with craniofacial conditions.

(25:38):

They have a unique relationship with NYU where they work directly with that craniofacial center to not just provide the surgical support, but also the psychosocial side, whether it be a therapist, a dietician, a speech therapist, all these different providers that are involved in helping patients get through that journey. Because it’s not just one surgery, it’s years and years of surgeries and a lot of other supportive care around it. I loved that experience, but again, I wanted to do something a little bit more. I don’t even know what it was, but entrepreneurial, I guess. I then moved to Bogota, Columbia where I worked as an independent consultant for the leading hospital there called Fundación Cardioinfantil.

(26:25):

My scope was to form a strategic partnership with Cleveland Clinic with the goal of converting this hospital into a future hub of healthcare by leveraging Cleveland Clinic’s brand, their IP, their know-how. That was incredible, because not only did I get to pitch to the Cleveland Clinic team, but I also got to work very hand in hand with their C-suite and some of their executives to understand how we could form this partnership to elevate Latin America to be a hub of medical tourism. I moved back to the US and that’s when I got this itch to fulfill that itch for entrepreneurship. I looked around at functional medicine, at primary care, at care delivery broadly, who’s doing something innovative.

(27:15):

I felt like after trying all of these different services, I just felt that I could do it better and that no one was thinking about it from the patient lens. I also met my co-founder at that time, and she was equally passionate about re-imagining healthcare from the lens of hospitality, really redefining medicine for the modern generation. We put our heads together and built The Lanby to be the utopic patient experience.

Mike Haney (27:47):

Quick sidebar, how did you end up going to Colombia? It sounds like a really interesting opportunity, but also maybe a bit random.

Chloe Harrouche (27:54):

Super random. My husband is Colombian, and he was very interested in learning more about the Colombian market. He was working for Blackstone at the time and somehow managed to convince them to let him go there and see what opportunities existed. It was going to always be a short-term experience, but we both, I think, learned a ton with respect to our individual careers, but it was also personally a very fun experience.

Mike Haney (28:26):

What did you learn there? You mentioned the ability to work closely with the Cleveland Clinic and the folks there, but what else did you learn about healthcare, particularly at the patient level, working in Colombia that you wouldn’t have learned had you stayed in New York or in the US?

Chloe Harrouche (28:44):

I think in Colombia, there’s this humanness to their care that is very special. It’s interesting because I think Cleveland Clinic is obviously years ahead of most hospital institutions in terms of the way that they organize their care, but I think what is unique about Colombia and it’s core to Colombians is that warmth that all of their providers have. That was very inspiring to me. I think in working with Cleveland Clinic, there were two things that stood out. One is just how much they think about the patient experience. There’s this whole department or team that is focused on making sure that they’re getting ongoing feedback from their patients and identifying ways to address that feedback.

(29:37):

Having that more continuous feedback loop was super important to them. Secondly, I admired the way that they leverage their brand, because medical tourism is something that’s growing increasingly and not just from the US to other parts of the world, but also from other parts of the world back to the US. There’s a lot to be able to get out of that trend. I think Cleveland Clinic alongside Mayo Clinic are the two institutions that are really moving ahead in building out these hubs in other parts of the world to leverage their brand and their know-how and form partnerships that are very lucrative for them. I thought those were two very interesting insights.

Mike Haney (30:23):

What have you learned in the time since you’ve launched The Lanby? You guys have been around a year, a year and a half, somewhere in that realm. Is that right?

Chloe Harrouche (30:30):

A little over a year.

Mike Haney (30:32):

What have you learned? What have been a couple of the biggest takeaways?

Chloe Harrouche (30:35):

I think the first takeaway is that patients more than anything want accountability. It’s not something that we knew for certain, but we always knew that people wanted personalization and they wanted follow up. Marrying those two together is where accountability comes into play. We have this personalized care plan that we provide all of our members, but it’s about how you follow up on that care plan and how you challenge people to stick to those goals and make sure that they’re actually following through.

(31:10):

That’s where the concierge manager is so essential to our organization, because we don’t just rely on the physician and the wellness advisor to deliver an excellent patient experience. Really the one who’s differentiating the value of the membership and differentiating us as a company from all the other players in the space is the concierge manager, from my point of view. She knows our patients inside and out. She follows up with them and organizes their care in a way that is beyond impressive. I think that’s what blows our members away and makes them feel that we have their back, that they can feel very secure in what we’re going to do to make sure that their care is managed properly.

(31:56):

I would say elevating the concierge manager is something that we always knew we wanted to do, but it’s really rewarding to see patients’ reaction to it.

Mike Haney (32:07):

That brings me back to my bugaboo about functional integrative care that we started with, which is scalability. Setting aside for a minute just the larger healthcare system within the US and how we scale within 300 million people, just as a business owner, how do you think about the economics of scaling a three person team model as opposed to a PCP who’s going to meet with you for 15 minutes, which while not great from a patient perspective, seems just on a baseline economic level faster and more efficient, how do you grow the business? How do you make the economics work taking this more personal and multi-person team approach?

Chloe Harrouche (32:50):

The thing to remember is that we focus on preventive care, which means that the doctor, as someone trained in the traditional medical system, is very good when it comes to diagnosing, very good when it comes to understanding the root causes, but not necessarily the one that’s going to be the person keeping you accountable. That’s where we’ve shifted the molds of primary care to be less focused on the doctor and more focused on that follow up. Our wellness advisor and our concierge manager work together very collaboratively. Of course, the doctor is always part of the conversation, but they’re the ones that are actually following through on your care.

(33:33):

Typically, our patients don’t meet with the doctor as often as you would think. They really are taking advantage of the wellness advisor and the concierge manager to get their questions answered quickly, to provide that follow up, to organize their care, to get them into specialists when they need to. I think that whereas traditional transactional primary care is very much like, oh, I have an issue, I need to go to my doctor to fix it, because we work so closely with our patients on being proactive and preventive and optimizing, that’s where we shift a lot of the utilization away from the doctor and more on the rest of the care team.

(34:11):

That’s the first thing. The second thing is the way in which we can leverage technology. Right now our technology is pretty limited and that’s because we’re a young company and we really wanted to understand where the gaps were from a technological standpoint before we started building anything proprietary. We’re now at a point though, and we’ve already built out the first iteration of our member dashboard, but as this next phase going into year two, we’re looking to integrate technology more into our workflows to alleviate a lot of the tracking and the task managing and the customer relationship management that our concierge manager is having to do manually and allow them to use these tools that will just allow them to be more efficient.

(34:55):

By that I don’t mean remove them from the relationship because I think it’s always important for members to feel that there’s a human at the other end of the conversation and not that they’re communicating with a bot, and having that person be a consistent person, not just anyone who’s on the receiving end of whosever on call.

(35:16):

For us, it’s about using technology to make the internal operations more efficient, to support members and seeing their health in a way that actually makes them feel like they can consolidate it all into one place and feel that it’s being well-managed, creating more of that feedback loop and that ongoing asynchronous conversation between our members and their care team, but not removing the human side of healthcare.

Mike Haney (35:43):

What tools or services, technologies are out there that you’re excited about that help in your approach, and I promise this is not just a plug to get you to say Levels, but like what we’re trying to do? We’re trying to take this approach of like, hey, here’s a window into your own body, what’s going on. Here’s a new data stream and some ways to think about it. I think we certainly feel like for a lot of folks they’ll get the most out of the experience if they have a primary care experience, like you guys are providing, if they have a medical professional or a wellness advisor that they can talk to about the data.

(36:18):

But what else is out there that is either on the cusp or coming or out there recently that you’re excited about that’s helping you guys do what you want to do with your patients?

Chloe Harrouche (36:32):

Levels is a great one, and I’ll just talk briefly about it. Not to give you guys necessarily the plug, although I think anyone listening is already obsessed with Levels. What’s amazing about Levels is that it gives us a good baseline and it allows us to, whether it’s every six months or every year, recheck where are patients at. Because people are very cyclical with their goals. There’s going to be a month where they’re unbelievable with their health. They’re not needing sugar, or they’re pairing their sugar or carbs with fat and protein, so their glucose levels look great, or they’re exercising a lot and they’re really motivated.

(37:13):

It’s summer. They’re in a bathing suit. They look great. And then winter rolls around and they’ve lost steam and they’re not as diligent as they once were. Being able to use a device like Levels allows us to provide the data that people need in order to really see how their body and their constitution corresponds to things that others might correspond differently to or react differently to. That’s a great tool for us. We also recently got an InBody composition analysis machine, which allows us to measure the ratio of your visceral fat and your lean muscle mass, which is, again, helpful to allow us to have another data point to measure progress.

(37:56):

It’s really always about using these tools to track and measure progress over time. The third one that I’ve always been really excited about is New Amsterdam Genomics. They are a genomics company. It’s pretty pricey, but you only have to do it once. The other trouble that we have with some of these other genomic tests is that research around genomics is changing so rapidly that you do it once, and then two, three, five years later, they’ve done research to find 50 other genes. You have to redo a test and pay another few thousand dollars. It’s usually not covered by insurance when they’re more comprehensive.

(38:31):

This one is not only very comprehensive, but it’s also leveraging AI to constantly update your results. They keep your genomic sequence on file and they pair it with whatever is available online to make sure that they’re giving you everything that’s currently relevant to your genes. Not only is it helpful to know what predisposition you have to certain diseases, but also in terms of diet, if you’re sensitive to anything, if you are more likely to, I don’t know, have an intolerance to something.

(39:11):

We’ve really enjoyed working with them because it gives us a very in-depth view as to how to think about health more proactively, especially for things that people would’ve no awareness of at this stage of their life, but they’re working towards minimizing disease for the long run.

Mike Haney (39:29):

How do you think about scaling both within your business, obviously you have a business, you want to grow it, but also scaling this approach? As somebody who’s passionate about this approach to medicine, I assume you would like to see more folks, even if they were outside of your clinic, getting some care like this. Do you feel like the role of businesses like yours is to basically set the example for the larger healthcare system of, hey, here’s an approach, here’s some things we’ve learned, so that they can start to be implemented in some of these more traditional environments?

(40:02):

Or do you see a world in which businesses like yours just simply grow in size to where through the efficiencies you’re trying to get, you can just take on more patients and slowly we end up with a world where 80% of people are seeing that kind of medical experience and maybe 20% are still on what we used to call the traditional medical experience?

Chloe Harrouche (40:20):

Definitely both. I think it goes back to what we talked about earlier on in the conversation, where ideally we’re starting to show the medical system how important it is to talk about lifestyle and wellness especially around primary care and how to elevate primary care to be an essential piece of the healthcare ecosystem. Because without primary care, we end up with way more rates of chronic disease that, again, are mostly preventable, and we end up saving a lot of money on the healthcare system.

(40:54):

I think that our mission is to really show the value of wellness, but also to be able to leverage our own learnings in treating various patients, to build protocols that are integrative, that leverage the best from functional medicine, integrative medicine, wellness modalities, conventional medicine, to put together protocols that are unique to The Lanby, but that will also allow us to be more efficient in providing that care to the masses.

(41:26):

I think it’s about reaching economies of scale, leveraging technology, leveraging other tools, and also being able to launch different membership tiers so that we can offer diluted versions of the membership to a broader audience that isn’t necessarily interested in the unlimited care or the in-person component, but they want to be able to access this three person care team model. They want to be able to access our specialist referral network, this integrative approach that’s unique to us. I think that that’s where we can get creative around how we’re able to meet the demand, but in ways that also make sense for us once we do have those protocols in place.

Mike Haney (42:10):

I love that idea of a diluted version. This is one of the things I think about all the time because my role here is education. I work in editorial. I’m not actually building the product, I’m writing the articles for the people who might never buy our product. But my message is always to people, look, there are a million things you can do to get healthier short of buying a product or putting something on your arm or on your wrist.

(42:37):

And just opening people’s eyes to we’d say the various wellness modalities or some of these ideas that, hey, blood sugar is a thing, it’s actually worth paying attention to even if you haven’t gotten a diabetes diagnosis, or hey, actually a little bit of movement after meals really is helpful no matter what you’re dealing with. Just opening people’s eyes to some of those things and taking a different approach to their healthcare as opposed to the, I guess, everything’s fine until I’m sick and then I go to the doctor and then they figure it out. I feel like there’s so much ground to be gained just in that space before we get anybody to actually sign up for anything or pay for anything.

(43:14):

I love the idea of using the experience in tools and things that businesses like yours are coming up with to just in as light a way as possible, open more people up to thinking that something like that approach is for them and not just for biohackers or rich folks over here or whatever.

Chloe Harrouche (43:32):

I think there is still a huge learning curve when it comes to wellness, and I think a lot of people feel like it’s binary. Either you’re obsessed with your health, or you just don’t have the time or don’t have the motivation, and you can’t be in between. I think the little things like making sure that you walk for five minutes after a meal, those are such easy, low-hanging fruit type of tactics that everyone should implement. Again, you don’t need a membership at The Lanby to do that.

(44:02):

You don’t need to use Levels to do that, but it’s just being able to help that movement, that education around the little that you can do to be just a little bit more conscious and aware I think will make a huge difference in saving our healthcare system. I think ultimately it’s all about how do we work together to make people a little bit more wellness conscious without having to be extreme.

Mike Haney (44:29):

What are you excited about in the coming year, either personally in your journey, as you talked about earlier, this journey toward slightly changing your approach to your own health or within the business itself? What are you looking forward to or what are some challenges that you’re excited to solve this year?

Chloe Harrouche (44:45):

It’s a great question. I think from a professional standpoint, we’re really looking to figure out how to be most efficient and also most in tune with what patients want. Really making sure that we’re staying close to our members and understanding what it is about our membership that they love, that they resonate with, and that they want to prioritize. We should be leaning into those things more so than anything else. Because I think when it comes to these flat membership models, all-inclusive membership models, it’s easy to just try to do a million things at once, but what should we be doing exceptionally well and let’s make sure we focus our time and energy there.

(45:27):

And then on a personal level, I would say I’m trying to just be as balanced as I possibly can, because I do have the tendency to be extreme. I’m working on actually taking a step back and trying to be a little bit more moderate. It’s a very interesting journey, not one that I would ever have thought I would be on, but I’m just trying to be very mindful and conscious of habits and how to be as even-keeled and also data mindful, I guess is the word, as possible. Not try to just do for the sake of doing, but really look at my data and see where I should do more or do less.

Mike Haney (46:13):

Sorry, I’m going to ask one follow up because I think that’s really interesting and something we talk about a lot here. If you’ve found anything thus far that’s helped you achieve that more balanced view and not letting yourself get too obsessed or too down a rabbit hole with one thing, but I’m curious, based on what you said at the end there, if the data is a tool that’s helping you do that. Do you find that just looking at your data, whatever that data stream is, as a way to modulate some of your instincts about how hard you might go in one area or another, if that makes sense?

Chloe Harrouche (46:44):

Yeah, labs, for sure, have been helpful. I think I’ll probably go back to a CGM soon. But for the time being, I’m just trying to get my hormones to be at the right levels, and so that’s where I’m focused on. Making sure that something as simple as I don’t eat coffee on an empty stomach. I don’t intermittent fast. I’m just trying to really chill my body down. I’m trying to use the regular labs to see how my cortisol, my hormone levels are stabilizing. And then once I get to a point where I feel that I’ve achieved that, then I’m very excited to get back on something like Levels so that I can also just see if my concern around carbs was well-founded.

(47:28):

Because the last time I used Levels, I was on such a kick where the worst thing that affected my blood sugar was sushi. I wasn’t eating dessert. It almost felt like it wasn’t worth it for me. But now that I’m starting to change my diet a little bit more, I think it will be a very, very different experience than the last time I used it. I’m excited.