We sat down with Gaurang Choksi, Founder and CEO of Violet, to discuss his journey and reason for building the first health equity platform.
Hanna: Can you tell me about your background and what inspired you to get involved in healthcare – first at Oscar Health and now Violet?
Gaurang Choksi: Healthcare has always been deeply personal to me. I grew up in India until the age of ten. I grew up on Medicaid for about ten years and I am a gay man. I had lots of experiences where, whether it’s being a translator for my parents or identifying as a gay man, I have always struggled to figure out, “what does inclusive care really mean?”. What I knew is I wanted a doctor that would really advocate for me, someone that would teach me what I need to know. Building Oscar for many years was such a privilege because what I got to see firsthand was that I wasn’t alone. People would call in all the time and say I want a black psychiatrist, I want a gay physician, I want a gay black veteran psychiatrist and so on. We never had the data of what lived experiences every doctor has. With Violet, what we are building is the first ever source of truth for looking at cultural competence and humility as a hard skill.
Hanna: You founded Violet in 2020. Can you share an overview of what you are doing at Violet and how you leverage technology to improve access and equity?
Gaurang Choksi: For many years, one of things we really wanted to do was build culturally responsive networks. What I mean by that is that every time Oscar entered a new service area or a new city, we wanted to make sure that the doctors we were contracting were the right doctors for the people we were serving. Let’s say, we know 23% of Chicagoans are Latin and we wanted to make sure 23% of the doctors were inclusive working with the Latin community. What we found though is that none of that data exists on the provider side. As a country, we don’t know how many doctors are diverse. The reality is we also just know there aren’t enough diverse doctors in the first place. With Violet, what we are doing is credentialling cultural competence as a skill. Essentially, for every doctor in the country we look at all the data we can on what communities they’ve worked with, what communities they belong to, what communities they want to work with, and other data points.
What is most powerful is the doctors are the ones in the driver’s seat. Violet looks at lots of data including medical and pharmaceutical claims and give the doctor a profile, almost like a Netflix, where when they join not only do, they see all the information we know about their experiences, but we also give them clinical education to become more inclusive. The education includes everything from how to be a better ally to how to address key disparities for every community. When we look at our data and the impact we have already had, what we are seeing is that across our partners, the companies that leverage our data to either build better patient provider relationships or that use the training to upskill doctors, are doing a much better job delivering healthcare. With one partner, we saw that the doctors that did our trainings were able to get hypertension and diabetes under control at a much better rate than the doctors that did not do the training. With our partner, Octave, we have a case study where we saw that clients that got to a certified inclusive provider showed a 14% improvement in patient retention rates because they trusted the provider more.
Hanna: I would love to get a little more granular on the problem Violet is addressing. Could you touch on the problem you are addressing with Violet?
Gaurang Choksi: As the country that spends the most on healthcare per American, our healthcare system is fraught with disparities. One disparity that is personal to me is that gay men in America have 20x the rate of colorectal cancer compared to other communities. I have been out since about 16 and it took me until the age of 30 to finally go to a primary care doctor that said I should get an HPV vaccine. It means that with appropriate vaccination and preventive care, I could make sure I am not contributing and compounding the disparity that is there for colorectal cancer. Now, if we take that example and apply it to every community, there are rampant disparities across every community. With Violet, what we are doing is looking at the data to help every patient get to an inclusive provider that is going to advocate for us.
Hanna: Data plays a huge role in what you do at Violet, can you touch upon the many challenges that come with healthcare data and how you are working to turn data into action at Violet?
Gaurang Choksi: You hit the nail on the head. There is a lot of data and not enough actionable insight. What I mean by that is that in our country, we have all the data that we want on what every provider is doing. What we don’t have is how we take all those data points and turn it into action and how we solve problems that are worth solving. The problem we are solving is how do we make sure that every patient can get to an inclusive provider. Whether it is upskilling provider or credentialling providers, we are taking messy data, structuring it, and giving providers the agency to say you can upskill yourself. What is most exciting to me is turning lots and lots of data into meaningful insights that are directly improving health outcomes, and we need more of that in our country.
Hanna: I would also love to dive into the policy and regulatory tailwinds. Can you speak a little about this?
Gaurang Choksi: What we see today is that half of America is covered via Medicare, Medicaid, ACA, or CHIP insurance. Essentially, they are public programs by the state or federal government. We are seeing policy makers extremely focused on building health equity and thinking about the many different levers to build health equity. We have been seeing policy work related to expanding the workforce. For example, doula coverage with Medicaid in certain states or including better representation and advocacy for community health workers. One lever that has directly impacted our work at Violet is the push to understand the diversity and the skill set of every single network. In states like Colorado, we have seen the Department of Healthcare really advocate and ask all Medicaid MCOs to build and scale culturally responsive networks, and they are asking for clear strategies on what that means. With Violet, all our analytics can really answer those questions, and we are the partner working hand in hand with each MCO to make sure the state has what they are looking for. However, what we have seen is a huge push at the federal and state level for better education that is impactful. Policy makers have been clear that they do not want a one size fits all HIPAA-like compliance training. They want training that will teach providers about disparities and how to address them. In states like California, we have seen some legislations passed where this state is asking every Medicaid plan to objectively train both their internal staff and all network providers on inclusive care and give the data back to the state showing that the education was done. Violet is a multiplayer platform with provider profiles so as the training is done, we can let every plan know. Through this, we can remove administrative friction as well, which has been huge.
Hanna: How would you describe your leadership style and how it evolved since starting Violet 4 years ago?
Gaurang Choksi: I grew up distance running. I used to run about 13 miles a day all through high school and building a company truly feels like that. There is a lot of resilience needed because every single day there’s different problems. What I experienced in the last few years is how do I build that balance and build my own skills of being both a good founder and a great CEO. So, for the first three years of the company, our focus was on finding product market fit, building a version one of our platform, and finding our early customers. Over the past year, I have been focused on working closely with my team to make sure that not only do we have phenomenal product market fit with many Medicaid plans, but on top of it, making sure we have the talent internally where all of us feel empowered and have agency to keep learning. Oscar was such a privilege because as the company grew, I got to take on many different roles and responsibilities. I want to make sure that everyone is constantly taking on new work that is personally fulfilling to them as well.
Hanna: Looking ahead, what are you most excited about for Violet? How do you see the market evolving in the next few years, and where does Violet fit into that vision?
Gaurang Choksi: Honestly, I am a very pragmatic person and having worked and built a health plan for many years, I think pragmatism is underrated. I have heard every healthcare CEO talk about wanting to have an Amazon like experience, where every single patient has a care team that really advocates for them and supports them end to end. What I believe is that for that to become a reality, we are going to need innovation like Violet, where we make sure we see what every single patient is going through, what communities they belong to, what social determinants they have and more, and then pair every patient with the best possible care team. I am excited about having infrastructure that directly contributes to building health equity in our country. So far, what we have seen is that by having the audacity to say cultural competence and humility is a hard skill, there is movement and momentum in the healthcare industry.
Hanna: Do you have any advice for founders?
Gaurang Choksi: The biggest advice I have for all founders is to get comfortable with rejection. When I look at the past four years, I have dealt with more rejection than I ever have in my life. There are a lot of resiliencies to be built through that journey. If you are a kind and clear person, I have found that the people delivering rejection to me can be very collaborative and constructive. Several of our investors and customers are parties that we initially met and might not have been ready for a partnership, but they came back, and we formed an amazing relationship. All of this to say, keep your eye on a longer-term relationship because that is how we really can create value.
Hanna: What has been the most rewarding and/or challenging part of your journey with Violet so far?
Gaurang Choksi: For me, the most rewarding part is the impact. We have quite a bit of clinical research published but there is nothing that feels better than seeing that people are getting better faster and staying healthier longer because they have a culturally inclusive provider. We are improving health outcomes and that is why we do the work we do.
Hanna: Lastly, anything you wished I asked or anything else you would like to share.
Gaurang Choksi: One thing I have been thinking a lot about is a health equity tech stack. We had a national health plan ask about this. Essentially what they were asking is what is the technology we need to build health equity in our country. This is very comparable to my own thinking, which is we are going to need innovation in infrastructure and phenomenal tech enabled services. The reality is we do need innovation where there are care teams that are objectively focused on specific communities. At the same time, I think we need infrastructure like Violet so that we can make sure we are finding and making clinicians more inclusive as well. I love that intersectionality of infrastructure coupled with tech enabled services.
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