Zach Reitano: US healthcare must answer to patients

Zach Reitano argues that a central problem in American healthcare is that the patient is often not the customer at the point of purchase. In his view, whoever controls the money becomes the stakeholder around whom the system is built, while people paying indirectly have difficulty seeing what care costs.

Asked how much of national income should go to healthcare, the Ro co-founder says the share could be much higher if spending produced more healthy years. He thinks the more useful question is what people receive for each dollar, rather than treating a particular percentage of GDP as inherently too high.

Reitano distinguishes the cost of a unit of care from the total a society spends. His argument is that a cheaper unit might invite more use, whereas, in his account, much of the present U.S. spending reflects rising prices per unit.

He describes U.S. healthcare as stronger at acute care than its reputation suggests, but expensive and burdened by administration. He separates sudden causes of death, such as accidents and overdoses, from chronic disease, which he calls a slower clock. These categories shape his explanation of where spending goes.

Reitano sees a mismatch between a patient's lifelong interests and the shorter horizons of organizations paying for care. People finance the system through premiums, taxes, wages and out-of-pocket spending, he argues, but often cannot direct the money when an individual purchase is made.

As examples of markets in which patients pay directly, he mentions eye surgery and cosmetic procedures. He argues that putting the person making the choice closer to the transaction can put pressure on price, convenience and quality.

He makes a similar case about direct-to-consumer sales of GLP-1 medicines. Reitano says some advertised or list prices once around $1,300 have been followed by much lower direct-pay offers, citing $149; the comparison is his account of changing offers, not a statement that every formulation or patient pays the same price.

Reitano considers the objection that a consumer may know less than a clinician. He acknowledges the information gap but thinks choice and the ability to leave a provider offer patients a form of recourse. He also argues that prices should be visible before the purchase rather than treated as an achievement only after a disclosure rule.

His hypothetical alternative would put a healthcare budget under an individual's control, with separate catastrophic insurance. In his view, providers would have a reason to display prices and earn repeat business. He presents it as a model for changing incentives, not an account of the system as it exists today.

Ro has four main areas, Reitano says: cardiometabolic health, sexual health, dermatology and fertility. He describes GLP-1 treatments as the fastest-growing part of the company, and says its revenue run rate grew from roughly $250 million to more than $3 billion over four years.

Asked why people use Ro rather than drugmakers' own direct services, Reitano lists insurance checks, cash-pay options, delivery or pickup and multimonth programs. He says the company works with both Novo Nordisk and Eli Lilly, and regards continued innovation rather than one fixed feature as the durable source of differentiation.

He says Ro built its electronic medical record, laboratory, pharmacy software and provider network before GLP-1 demand accelerated. The infrastructure was designed to serve more than one condition, allowing the company to expand when a new category grew.

The host asks how a distributor earns a place when relatively few manufacturers make the medicines. Reitano thinks inventors should capture more margin than firms that extend access. He compares the attraction of a demand aggregator to a retailer that helps suppliers reach customers while offering members convenience.

Looking ahead, he separates individual effects, changes to the healthcare system and possible wider social effects. He argues that sustained consumer demand for GLP-1s is prompting questions about insurance coverage, transparent prices and who gets to make treatment choices.

Reitano points to the pandemic-era relaxation of some cross-state telemedicine restrictions as an example of what can change when demand and policy move together. He says a shortage of clinicians remains a constraint and questions whether the previous rules always serve patients well.

An employer makes coverage decisions for a changing group of employees, he says, while an individual considers their own and their family's health over a lifetime. He sees that difference in time horizons as a reason employer and patient incentives can diverge.

His motivation is personal. Reitano says his father, a physician, helped him navigate a serious heart condition and a procedure at 18. He also describes his parents' efforts to obtain treatment when his growth stalled as a child, and credits their advocacy with changing his own trajectory.

He extends that experience into a broader argument: improvements in health can change what people are able to do with their lives. He believes earlier action against chronic illness could likewise affect society, although he says its full consequences cannot be predicted.

Asked for a forecast, Reitano predicts more than half of Americans could eventually use a GLP-1. He acknowledges that some people should not use the medicines or cannot tolerate them and that affordability matters. The forecast is his, and the clinical suitability of any particular medicine depends on the individual.

On new technology in care, he wants evaluation to concentrate on outcomes rather than whether an input is human or automated. New methods should have to demonstrate meaningful benefits, he says, but existing practices should also be assessed rather than receiving an automatic pass.

He uses driverless cars as an analogy, arguing that a discussion focused only on displaced jobs can neglect lives that might be saved if a technology proves safer. His broader claim is that society should weigh demonstrated outcomes and the costs of delaying useful changes.

O'Shaughnessy turns to Ro's turnaround. Reitano says the company refounded itself in the summer of 2022, after he had recognized a problem in December 2021. Earlier that year Ro had raised $500 million at a $5 billion valuation, but he says it had tried to do too many things and hire for all of them at once.

Reviewing annual results on a flight, he saw 9% growth despite substantial resources and years of work. He describes a business that was neither growing fast enough to justify its ambitions nor running immediately out of cash. The realization prompted a long memo to his co-founders about the need to reset.

A complaint about the packaging of an employee holiday gift became, for him, a symbol of the disconnect he felt. His initial anger gave way to frustration with his own leadership: he believed he had not been clear enough about how the company intended to work.

The following year, Reitano says, Ro parted ways with several vice presidents and then about 20% of its staff. He says layoffs are painful and should not be celebrated, and that avoiding excessive hiring would have been better. He distinguishes a mismatch with a particular workplace from a judgment that a person lacks talent.

The reset brought separate brands under Ro and made the company's expectations explicit. One stated principle was to work hard; Reitano says the point was to make clear both what the organization was building and the working style it expected.

He describes the desired culture as one that strongly attracts some people and repels others. His restaurant analogy distinguishes a feature of the menu, which a customer might simply dislike, from a mistake in execution, which should be fixed. A lack of context needed to do a job, he says, is the latter.

After the new expectations were presented, he says, another 6–7% of staff chose to leave. Reitano reports that the business subsequently grew roughly tenfold while headcount fell from around 600 to a little over 400, though he also recognizes the strength of the GLP-1 market as a major tailwind.

He traces part of the earlier problem to the first hundred hires, most of whom the founders already knew. Shared assumptions had spread informally, he says, but did not automatically carry into a larger organization. His advice is to make the expected way of working explicit and protect it.

The host asks how much of the growth came from market conditions and how much from execution. Reitano answers that both mattered: a generational wave helped, but companies exposed to the same opportunity did not all capture it equally.

He says Ro invested in its strongest employees through compensation, equity, coaching and resources. He also credits a decision to work on a smaller number of initiatives in sequence instead of spreading attention across many projects at once.

Parallel projects can appear to move more things forward over a short interval, Reitano says, but concentrated effort can carry the first project much further. In his account, completing one thing can also make the next one more valuable because it builds on the first.

To increase speed and alignment, the leadership team met at 8:50 each morning for two years. A meeting might last minutes or much longer, but a daily commitment made it difficult for an owner to leave an agreed next step untouched for a week.

Ro also reduced its reliance on detailed long-term road maps. Reitano says this was a response to rapidly changing conditions in GLP-1s and AI, not a recommendation for every company or an excuse to avoid rigor. The team kept a broad long-term direction while trying to be precise about the next steps.

Reitano sees three forces potentially changing care: more health information becoming digital, AI tools that can interpret information, and new treatments. He expects the combination could make forms of attentive, continuous care less expensive and more widely available.

He wants to use lab results, wearable data, genetics and patient reports to investigate why treatment responses and side effects differ. He frames earlier detection of disease as an aspiration and a research question, rather than a result the conversation establishes.

When O'Shaughnessy asks whether he should take a GLP-1, Reitano does not give a blanket recommendation. He says he would start with the person's goals, family history and tolerance for risk, then discuss the possible benefits and harms with a healthcare provider.

Reitano describes working with his father and clinicians over many years on his own health. He says his family history of heart disease made him willing to pursue an aggressive approach to cholesterol; he adjusted treatments while watching measurements and potential side effects. He recognizes that the balance he chose may not suit everyone.

The discussion moves to drug discovery. Reitano describes the long path from a genetic observation involving PCSK9 to therapies intended to lower LDL cholesterol, and argues that medical data and AI might help shorten future discovery cycles. His account is a view of the opportunity, not evidence that the whole development process can be skipped.

Asked what he means by recreating his father in software, he says his father devoted his life to helping people gain healthy years. Reitano hopes technology and operations can extend that sort of attentive help to more people than one doctor could reach directly.

He says a sense of purpose often becomes clearer in retrospect. As another example, he describes his wife Cleo's work explaining technology and the influence of growing up around her father's careful legal arguments. Both, he thinks, came to understand their paths more fully by looking back.

In marketing, Reitano says Ro starts with the overlap between what a patient wants and what they need. Asking only what a clinician thinks a person needs, he argues, can miss the patient's priorities. He presents the approach as central to building a consumer relationship.

Reitano says the company uses language models to categorize incoming messages and route reported side effects to a healthcare provider. He describes a service target for response times and argues that a new care model must produce evidence of outcomes as well as make claims about convenience.

He says the company combines data with stories in its advertising, especially in areas where people may feel stigma. Campaigns featuring well-known people are intended to make it easier for someone to acknowledge a concern and seek help, he explains.

He cites Serena Williams and other public figures who have discussed their own experiences. Reitano says his co-founder Simon looks for people with a genuine connection to the product and builds campaigns around their stories, rather than celebrity attention alone.

A subway campaign about weight-loss medication drew criticism, he recalls. He interprets the reaction as evidence of discomfort around the subject and argues that stigma can obscure unmet demand. O'Shaughnessy asks how consumer founders can understand the tension around such topics.

Reitano discusses public discomfort with the possibility of ongoing weight-loss treatment. He says people should be able to make a safe decision to stop treatment without judgment, while comparing recurring treatment decisions to other forms of continuing care.

The conversation returns to the mechanics of celebrity campaigns. Reitano says recognizable people with relevant personal stories can help an advertisement stand out as inexpensive AI tools make polished visuals easier to produce.

Asked what stigma still interests him, he raises preventive use of medication and the different social reactions to medicines, alcohol and food. He frames his own approach around weighing risks and benefits with expert involvement.

On founder culture, Reitano says the attention given to one person often leaves out a wider support network. He credits his wife Cleo, who supported them financially early in Ro's life, and the team that helped build the company.

For the host's closing question about kindness, Reitano remembers being homesick at boarding school and arguing with his parents during a visit. Before they drove away, his father asked him to say he loved him. Only later did Reitano learn his father had been having a heart attack and was on his way to the hospital.

His father survived and told him he had not wanted an argument to be their last exchange. Reitano says the experience taught him to express affection rather than leave it unspoken; he now tells family, friends and even his co-founder that he loves them.