Andreessen Horowitz-backed knownwell, a hybrid weight-inclusive primary and metabolic-care provider, announced it is opening a new brick-and-mortar clinic in Plano, Texas, and will treat patients virtually throughout Texas.

Vineeta Agarwala, general partner at Andreessen Horowitz (a16z) Bio + Health, which led the company's latest $20 million Series A funding round, sat down with MobiHealthNews to discuss why the VC firm invests in knownwell and the company's expansion into the Dallas metroplex.

MobiHealthNews: Why is Andreessen backing knownwell?

Vineeta Agarwala: Usually, when we invest in any startup, we're early stage investors and care a lot about the team. Having a really rock star team that is capable of executing in a complex healthcare landscape, that's capable of growing, hiring, delivering clinical care, that we're all going to always feel proud about, are the first filters for us on any business, and this team passed that bar with flying colors.  

It's true for a lot of our portfolio that many of our companies actually have clinical cofounders or very early clinical influence on their management teams. That is important, as you might imagine for me personally. I always want to know that there is a clinician on the other end, who shares the instinct with respect to keeping patients first, patient outcomes first, patient experiences, and just deeply values that sort of clinical code, if you will.  

And then every startup needs to be operating in the right market at the right time. And that's obviously true in this case for knownwell. 

If you look at any of the reports about why America is lagging relative to other developed countries, like The Commonwealth Fund Report from 2022 that got so popular with respect to why we were last on every measure, the real cause is obesity. We struggled with the COVID pandemic because of obesity. We struggle with maternal and neonatal health outcomes, in part, because of obesity. We struggle with cardiovascular health outcomes because of obesity. It is the underlying problem that is, in some sense, the curse on American demographics and American health. And we've never had a treatment.  

So, for the first time in decades, we have a highly effective treatment that now needs to be integrated with other treatments in our arsenal, including behavioral health, dietary modification, surgery when appropriate and side effect management of those therapies. And I think we're going to have to figure out new ways to scale access to that care. So it could not be a better time in the market, and we couldn't find a better team.

MHN: Can you tell me about knownwell's expansion?

Agarwala: One of the things we really liked about knownwell is that they started with this orientation around, almost perfectionism. They started a Needham, Massachusetts, clinic in a location that Angela [Fitch, founder and CMO] has known well, no pun intended.   

She practiced at MGH [Mass General Brigham] for many years, set up their weight center, and developed a wait list of thousands of patients who could not be serviced by the traditional academic health system model. But it was a zone she knew well, a patient population she generally knew well, a set of referring partners that she knew well … and we wanted to get every detail right. If you talk to Brooke [Boyarsky Pratt, founder and CEO], she always makes the joke that we were running with limited funds, but in a way that we were never going to let anybody down.  

It was a small, controlled operation that we really liked because that was a setting in which we felt like the data on patient experience and patient NPS and patient feedback and patient outcomes and clinician experience and clinician feedback and clinician adherence to the knownwell care model could all be optimized.  

We liked that dataset and that first set of experiences that the company had built and thought that this was the best care model that we could see to then take into other geographies. So, a big part of our Series A interest was in seeing if we could help support the company to scale this kind of approach to multiple other geographies, to multiple other partners nationally. 

It was really important to us that knownwell largely acquires patients, not by paying for excessive marketing, but through what I always think of as the best patient acquisition channel, hands down, which is a clinical referral. 

From an investment perspective and a business operations perspective, it is the most authentic and free form of patient acquisition you can have, and it's also the most clinically rigorous. It shows that your service is one that is indicated clinically and that the evidence supports a need for this patient to access obesity medicine care.

For a variety of reasons, which, again, Angela witnessed while she was at MGH, tons of physicians wanted to refer their patients to obesity medicine specialists. That's what we saw that this could be–a receiving vessel for the vast, huge numbers of obesity medicine demand and access that exists among both patients and providers.  

It is partially to be able to access a new, transformative class of therapy. It is also to be able to access care in a setting where the providers have time to holistically take care of you. It is also to access care that is fundamentally unbiased and nonjudgmental. And it's to be able to access care that is a hybrid of in-person and virtual, and so that's what the Dallas expansion is.

MHN: What's next for knownwell?

Agarwala: We are very much in a mode where we feel like the core care model is highly effective, and so the job ahead is to figure out how to continue scaling it to more geographies, more patients, more referral partners, and to continue leaning into the hybrid care model of both virtual and in-person. So, I think you'll see us in more places beyond this first expansion outside of the Massachusetts area.

MHN: Is there anything else you would like to add?

Agarwala: Another thing that is worth noting is that, in our experience, getting this kind of expansion right does require leaning into and figuring out what the technology that you need is to support a really well-functioning hybrid care model. That's another aspect of this that the company has been doing, maybe a little more quietly. It is a core thesis for us, that incorporation of really great software and technology and virtual care approaches are what's going to keep quality high even as you scale, and it's a huge commitment from the team and the board as well.