Virta Health: Scaling a No Ego Culture & Reversing Diabetes | Amit Shah (Podcast 566)

Every single Monday for the last 9 years, we have a company all-hands and we kick off the company all-hands with one of our patients talking about their experience. Every single week we have them join the virtual call, the Zoom call or the Google Meet call, and talk about what worked for them, how it worked, what the impact has been on their life. That's so centering for us. That is what we exist to do. We exist to reverse metabolic disease in a billion people. And we get one of those people every single week to tell us if we're doing our job.

Today's guest is Amit, the Chief Operating Officer at Virta Health, a company on a mission to reverse type 2 diabetes through personalized, evidence-based care. Amit joined Virta back in 2016 and now leads both the product development and patient care delivery teams, helping scale a model that's changing how healthcare is delivered across the US. Before Virta, he was an early team member at Paladina Health, a direct primary care subsidiary of DaVita, and helped to grow its footprint as VP of Operations. His background also includes time at McKinsey, Amazon, and even co-founding a renewable energy startup focused on serving people living in poverty. In this episode, we dive into how Amit and his team develop long-term talent and build culture that lasts, what it means to stay grounded in mission while scaling fast, and how he personally plans his week to lead with clarity and focus. If you're a leader looking to grow your people, protect your culture, and run a purpose-driven company at scale, this conversation is packed with gold. Let's dive in. We are live with Amit. Welcome to the show.

Thank you so much, Savannah. I'm so excited to be here.

Of course. Let's talk about Virta Health. That's the company that you're working with. Tell us a little bit about what you do and who you serve.

Uh, of course. Um, maybe I'll start with myself. Uh, I'm, as you said, Amit, Amit Shah. I'm the Chief Operating Officer at Virta Health. I lead our, our growth, product development, and patient care teams, which means I spend every day working to get more people to improve their health using Virta. Uh, and let me take a minute and tell people what Virta is. So Virta is on a mission to reverse metabolic disease in 1 billion people. And I know that's a lofty mission. So let me take a moment and talk a little bit more about what that means. We take a fundamentally different approach to metabolic disease by using personal biology to optimize nutrition and heal people's metabolism. We really address the root cause of the problem when it comes to metabolic disease. We guide patients in making sustainable lifestyle changes that lead to metabolic health improvement that, like, you know, these are the key improvements that we have. We, we show weight loss of about 10% of body weight sustained through 2 years. We have proven a 56% reduction in stroke, heart attack, and death, and we significantly lower the risk of diabetes, chronic kidney disease, fatty liver disease, among a variety of other ones. And most importantly, this results in, in like really happy patients. I always say we add lives to the year, we add years to the life of our patients. And we put more life in those years. Internally, we joke about having like a partnership with Levi's given the hundreds of thousands of pairs of jeans that people have replaced, or, or hear from grandparents about how they can now play with their grandkids and take them to Disneyland. So that's a little bit about Virta and a little bit about me, and I'm super excited to share more with you today.

Who is an ideal client?

Yeah, we, You know, unfortunately for us, for not for Virta, but for, for our society, 93% of people in America are somewhat metabolically unhealthy. And so for me to answer that question, it's truly like we can really be helpful to everybody. I think at the root cause of the problem that we see today in healthcare around metabolic disease and the incredible prevalence of metabolic disease is actually food choices. And you don't solve a food problem with drugs. So just as we have many new drugs that people are excited about that they think will solve this problem, we actually, because we solve the root cause of the problem, it could be impactful to anyone. Now, that being said, healthcare is an interesting space and our go-to-market is B2B2C. And the reason for that is we like to be value-based. We partner with our— with, with risk-bearing entities. So self-insured employer groups such as United Airlines or US Foods, etc., and other health plans. So Blue Shield of California is a large partner of a partner of ours, for example. And so we partner with organizations like that and then we serve their members. And so we have a variety of members across all 50 states. Hundreds of thousands of people, but generally through a covered plan.

And how does that work? So if I'm someone that I'm working at United Airlines, what, what do I get or how is this going to— yeah, what's the protocol?

Yeah, you would hear about us through your, through your benefits. We would send an email or a direct mail or something to you to educate you that you have access to something like Virta. And then you would, you would, you would like to sign up. So you'd come to our website and you'd give us your information, virtahealth.com, join now. Once we have your information, starting from, you know, starting from the, your first interaction with us, we start to learn more about you and personalize our approach, personalize our, you know, both what you need to do for enrollment and what you need to do in order to improve your health. And so as you go through that process, you meet clinicians from Virta, doctors, health coaches, and nurses, and they are really responsible for putting together that personalized plan of what you— what your food intake and macronutrient balance should be to optimize your health. Then we send you a kit that includes the ability to track biomarkers like weight, glucose, blood pressure, ketones, just a variety of biomarkers. That give us and you an objective feedback loop as to how your body is responding to the changes we're making. And as, uh, and then we deliver all of our care via our app. And in our app, there's personalized content. Uh, we're educating you on how your body is reacting to the changes while we're educating you, um, or giving you a variety of different, um, interventions. Hey, try eating this versus that. Try doing this versus that. Our doctor is, for the most part, de-prescribing medications. Again, we're a net de-prescriber. We tend to take people off of drugs like insulin, GLP-1s like Ozempic, Mounjaro, Wegovy, Zepbound, etc. We take people off of SGLT2s, etc., etc. So we tend to take people off of drugs, manage their statin intake. And then there's a community in our app of other, of other patients that are doing the same thing that you can interact with, and that often helps. You know, often we see questions like, well, I'm going to such and such restaurant in this town, what can I eat? And, you know, we have a, we have a patient community of hundreds of thousands of people. So oftentimes people have experienced that and will, will lay in, or if you're just struggling with something, you can again talk to your health coach, talk to your doctor, look at our content, or you can, or you can talk to someone in the community. So, so that's kind of what you get. That's kind of the process. And over the course of the first few days, weeks, and months, we see pretty significant health improvement that helps people continue to stick with the plan for a very long time.

That sounds super impactful. Amazing. Yeah. And how did this start? What's kind of the beginnings of the company?

Yeah, Virta started in 2015, and we— the first thing that we did, you know, I was, I was not on the founding team, so I joined in 2016, about a year after we got started. There is a wonderful origin story of the founding team. I won't do it full justice, but I'll give, I'll give the abbreviated version here. Our, our co-founder and CEO, his name is Sami. Sami had founded a company called Trulia, which is a real estate market, real estate marketplace company. He had built it from the ground up. IP, they, they went through an IPO and eventually they got, they got bought by Zillow, which is another real estate marketplace in, in the space. Towards the end of his tenure at Trulia and Zillow, Sami was a performance athlete including winning the Ironman for his age group, you know, I think in 2012, don't quote me on the year, but in that timeframe. And soon after he did that, he went to the doctor, got labs as, as folks do and found out he was pre— he had prediabetes. And that was, that was a turning point for him. He looked, he, he thought, wow, that's, How can I have prediabetes? You know, I, I, I literally just won an endurance race, you know, for my, my age. And so as he did a lot more exploration, he learned that the driver of his metabolic disorder was actually his nutrition, the way he was fueling his workouts, et cetera, et cetera. And that led him to our other co-founders, Dr. Steve Phinney and Dr. Jeff Volek, who had done decades of research on this, on this metabolic disease and metabolic health improvement. And Sami just had a light bulb go off. He said, man, I could help so many people if I can get this science in their hands. And what's the best way to get this science in their hands? Well, it's to do it via technology. And so the first thing that we did, this is back to 2015 where I started this story, is between Dr. Phinney, Dr. Bullock, Sami, and Dr. Hallberg, who was a physician in the obesity group at Indiana University, we launched a clinical trial. And so from 2015 to really 2020, we, I would say we were in R&D mode. We did all, we did, we, we have a clinical trial. All the results that I'm talking about are, have been peer-reviewed and published in our clinical trial in terms of our ability to help people drive weight loss, drive A1C improvement, get people off of medications, drive cardiovascular risk improvement. All of that has been studied. We took, then took that trial and we began to commercialize. And over the last 5 years, we've got literally hundreds of clients across the country. And like I said, we've served hundreds of thousands of patients across every single state in the, in the, in the US.

Wow, that's amazing. How did you get involved? So you came in a year later?

Well, yeah, I came in a year later. Uh, I, I, I would say it's better to be lucky than good. Uh, Sami reached out to me relatively cold. He, you know, we, he knew of me through the broader network of, folks that work in healthcare and folks that had kind of gone to the same schooling, through the same schooling that we had. And he reached out to me. When he reached out to me cold, I honestly wasn't looking for something new at the time. I was in a value-based care company that was based in Denver, which is where I live. And, you know, but, but, but I got curious. And when he first told me what Virta did, I honestly was quite skeptical. At that time, especially because I'd worked in healthcare for a little bit of time, this concept of disease reversal did not exist. And so it was very surprising to me that he was talking about disease reversal. And it took me a couple of meetings with him before I even started to accept the premise, so to speak. You know, then what happened was he introduced me to and shared some— shared some of our early clinical trial results. As well as allowed me to, to, to talk to some of those patients and some of the clinicians and all. And my mind was blown. I'll never forget, you know, hearing about one of our first clinical trial patients who she came off of. Well, what was she— when she started, she had an elevated A1C, so her blood sugar was outta control. She was overweight, she was on multiple medications, et cetera. She had diabetic retinopathy. In a way where she, she struggled to— her eyesight was, was poor. And over the course of 9 months at Virta, she had lost so much weight that her knee and hip pain had reduced. She, her A1C was now in a normal, at a normal level. So her blood sugar was controlled. She had come off of all of her diabetes medications, insulin, GLP-1, SGLT2, sulfonylurea, et cetera. And her diabetic retinopathy had improved so much that she was able to start driving again, which, which meant she was able to go get a job. And without going deep into my background, I have always tried to work in spaces where I felt like we could improve the quality of life for people. So I remember after that feeling like I might be skeptical about this, but gosh, I can't think of a better place to spend my time. And so I joined and, and, you know, I was an early employee at the time. Uh, and it has been an incredible 9 years of getting to work on this mission with this team.

What did that first year look like when you came in?

Savannah, you're really asking the hard questions. You're asking me to remember something 9 years ago prior to the— prior to my 2 young toddlers. I know, and it's hard for me to do. Uh, that first year, I remember focusing on a few big things. The key business thing we were trying to focus on— again, this was in our clinical trial phase— was to deliver great results for our clinical trial. So I would spend a lot of time with our coaching team and our medical team and honestly just looking at the data that we had about our patients and trying to learn more, figure out how we can help them be successful. In our, in our Virta method. Um, so that, that was, that's where I spent a good chunk of my time and a lot of it was education for me. I wanted to understand what we were doing. Um, you know, when I started at Virta, I, I have, I have a deep belief that great companies are built when you really understand the customer or the end user very well. And so I said, hey, I'm gonna try the Virta method. By the way, I thought I was pretty healthy when I started at Virta. I, you know, ran all the time and all these other things, not so indifferent than the story I shared earlier about our CEO. I ended up losing about 20 pounds in those first, in those first 2 months, or maybe a little bit longer than that. Maybe it was about 3 months, but I ended up losing a fair amount of weight. And I felt so much healthier that now 9 years later, I've stayed on the Virta treatment. Like I've, I've been doing it for, for the entire time that I've been here. And so there was a lot of that. There was a lot of just me getting in there and understanding both for myself, but also for our patients, from our clinicians, et cetera. The second big area of focus was around culture. Uh, in those early, in that early period, in that first year, I spent a lot of time with our first coaches. And at the time we're talking 10 people, 10 to 12 people, 10 to 12 teammates. Thinking about what we want this team to be. What is our ethos? What is our approach? Um, because in those early days, as you might well know, Savannah, from, from all the folks you've spoken to and your experience, there isn't a lot of process or product. You know, you are building that as you go, but you need a way to make sure that folks can make in-the-moment decisions and make in-the-moment decisions that align with where you want the company to be going. And so to me, that was creating a culture around putting patients first, ownership and accountability, being data, data and evidence-based. Again, we're running a clinical trial. That's something that we had to be driving. Impact, impact over busywork, those types of things. And so we, we spent a lot of time there. And then the third area was building process and product. You know, when you, when, when you had enough data on something that worked that you wanted to do more broadly, how do you actually create an operating system to, uh, enable people to do that at scale? And so that was, that was a lot of the first year. Um, and you know, when you, when I talk about it that way, it, it, it feels like I take some of the heart out of it. It was also just, man, it was so cool to be in a room with, um, 20, 25, 30 people in that first year. Who are just here for the mission, just here to impact as many lives as possible and, and putting the, the literally the seed in the ground and watering it and taking care of it so that it could flourish as it has, as it has now.

What did you guys do that you would attribute to the flourishing now? Like what were those early key decisions or focuses that you're like, man, if we wouldn't have done that, this may look very different.

There was an incredible focus on the mission, and there is today too. I've been here for 9 years, and so I can't speak to the, to the time before that, but every single Monday, we, uh, for the last 9 years, we have a company all hands and we kick off the company all hands with one of our patients talking about their experience every single week. And that is, we have them join the virtual call, the Zoom call or the Google Meet call and talk about what worked for them, how it worked, what the impact has been on their life, et cetera, et cetera, et cetera. And that's, that's so centering for us. Like that is what we exist to do. We exist to reverse metabolic disease in a billion people. And we get one of those people every single week to tell us if we're doing our job. Basically kind of working towards our mission. So that has been, that has been a key thing that, again, and that's been around since I've been here, so I don't take credit for putting that in place. That's Sami, our CEO, and our initial leadership team. But that has been around since day one. I think a second thing is along with that, um, what I, what I shared that we focused on in those early years, which is, uh, that culture of impact over busy work. Of ownership of decisions, of putting patients first. You know, one of, one of the big ones that I actually have, have loved over the years is one of our, one of our values is no ego. And the way that shows up is that I, one of the things I love about my job is I get to work with people that are here to win as a team. And so now, you know, it's hard to have people that have zero ego. And I'm, you know, we're not, we're certainly not saying that, you know, people shouldn't have any confidence and you know what, but it is great that we really come together to try to do what's best for the business because that is not just how we talk about what we do, it is the type of people that we try to attract and bring. And so I think those cultural points early on, so first of all, being very mission-driven. Second of all, being establishing the norms of the culture, establishing the, this is how we want to approach problems as a team was, was very, was very important. And I would also say those early hires that represented that, uh, you know, our tenure at Virta, we've got some folks with, with incredible tenure, people who've been here longer than me, 9, 10 years. And for a growth company, you know, that's not something that is that common. You know, often there's a, there's a lot of, a lot of turnover along that path. And so for us to have people that have been able to be representatives of that culture over that time and continue to grow, what that, what, what, what, what that also means is that we have teammates that had to grow into different roles. I mean, when you grow the way that we have, your job is different every kind of 12 to 18 months. It's a totally different job. So people that are able to grow with the mission, grow and understand what their new roles are, And so that was another, another thing that we focused on and made sure we, we tried to get right. I mean, nothing, nothing was done at 100%. Please don't interpret that. But everything was an effort that we put towards.

Great recap. I love the idea of bringing on a client live. I, I have done my team meetings with people bringing every single one of my recruiting meetings that I used to lead as an example for my recruiting team. We were a sales recruiting company. They would come with a sales rep that we had placed or a client that I've gotten one of our reps and done really well. And they would say, hey, shout out, like, we want to shout out this client. We would like rapid fire, everyone would give a client win. Everyone had to bring one and that was awesome. But I love this idea of having someone actually live. It just, it always feels different when you see their face and you know that they're sitting there right there and you can ask them questions. That's really powerful. So I just want to double click on, I will be scaling that in the future. And then I wanted to ask for these employees that have been able to uplevel and uplevel and uplevel time and time again, to be able to be with a company for a decade is very, very rare.

Mm-hmm.

What did you guys do in allow, like, what was the support blocks for those people? What allowed them to be able to do that while you guys were scaling so quickly?

Savannah, that's a really good question. The things that come to mind are first, having managed— helping our managers provide clear feedback to help people understand what the next job was. And I could— the way I think about this is because the job does change so rapidly, one of the things that needs to be done, one of the things that we have to do is share with an individual what their— and I'm now air quoting, I don't go to someone and say, your new job is— but share with someone what their new job is. And so one example is, as we scaled our health coaching team, you know, the job in the early days was to set up some processes and product and operating system, how coaches will work. The job after that, as we started in early days of scale, was to hire the right next set of people to continue the culture, to continue to, um, grow the team, et cetera. The job after that was to figure out how to hire a manager layer. You know, now, now we have like, now we need managers that are aligned and understand. The job after that might was around management infrastructure. Okay, now, now you have this manager layer, you have the right people, What is— how do you actually create a management infrastructure that then, you know, allows managers and ICs to be on the same page and managers and directors be on the same page and directors and VPs be on their own? And so being able to articulate that and share that and share those updated views as to what is most important for the business looking forward for the next 12 to 18 months. Is, is super important. And so I think that is one thing that we— our CEO, Sami, said this a lot, says this a lot, because he's—

he—

we had the blessing of having him experience high growth, a high-growth company. So yeah, the job does change every 12 to 18 months. And he said that, he said that early and often. And so I think that prepped us to say, to be looking forward and saying, okay, how's the job going to be different in the next 12 to 18 months? I think along with that, the second point I'll make is to be able to look backwards and have, you know, an accounting of the impact and ownership and, uh, and, and what's good and what's not. You've got to pair those two things. If you know what, what you need for the next 12 to 18 months, um, you have to be able to look at the leader and say, do you have that intrinsic skill set? Is that something you can be successful at? You know, let's, let's push towards that. Let's track it. Let's see how it works. And if not, is there a role that you could be successful at? I'm not saying everybody is in the same role a decade later. People aren't doing the exact same thing. Um, many people are here and have had 2 or 3 careers, you know, have had— we have a health coach who's a health coach manager, um, and now she does a lot of marketing work for us because it turns out educating the market on what we do, she's got this depth of experience in in, in our, in our treatment and our approach and our method that she could, but she's very good in front of crowds of people and, and sharing what we do. And so that's her career. And so there's also that. And again, she's one of these people who's been here for 10 years. And so she's had a couple of careers with us, um, because what was needed looking forward didn't align with what she was awesome at looking backwards. And then we were able to find a great fit.

So, so speaking of the job change, How has your job changed? You said you didn't start off as a COO role, correct? They didn't hire you originally for that?

No.

No. Okay.

So yeah.

How did you find yourself in the COO position?

Good fortune and, uh, and, and, and the blessing of having a great boss that I've loved to work with for the last, for the last almost decade. So my original role was to lead the care delivery teams, specifically the, the health coaching team. And again, at the time I joined, that was, I think it was 8 teammates and soon it was 10 and 12. It's kind of in that range. Uh, and over time, um, gosh, how did we get here? Uh, over time, uh, it, it's that exact process. I saw what I was good at looking back, looked forward and decided what we needed, and that meant adding, you know, the enrollment and support team at some point and the, the supply, our supply chain approach at some point. And, you know, like the things that slowly got added. One of the, one of the through lines, the big through line was care delivery. It's like how we deliver care. A big change in that was in 2021 or so, we decided to integrate the product development and the care teams. Because at the end of the day, we deliver all of our care via, you know, via app. And so we don't, we were like, you know, have a virtual clinic in that sense. And so the app experience and the care delivery experience being more integrated, that's where a lot of magic happens. A lot of us being able to proactively intervene with a patient comes from, we have intense machine learning models that we have built over a decade with hundreds of thousands of patients. You know, we've got literally hundreds of millions of data points that we are helping personalize our approach. So knowing what Savannah needs at a given time and then having the right intervention, whether that's from a human or from our content or from training, that was a lot of the magic that we were able to create to be able to scale our intervention. So bringing those two things together made a lot of sense. And so luckily Sami, our CEO, looked forward and said, hey, if we bring these two things together, that would be really valuable moving forward. And Amit, I think you can help us do that. And so that was a big piece of it. And then A couple years later we were looking to, as, as an extension of that, we realized that, hey, what you do up funnel, how you bring someone in is really important. So then I kind of took on that role. But at each step of the way, as I reflect on it, it was a, it was the process that I share. It's like looking backwards, what was I good at? Could I, you know, could, could that be leveraged in a, in a different way? And looking forward to what do we need? And then making that market. And look, there are times where, I stepped in a role for a period of time and then stepped out of it. You know, that's another thing that happens in growth companies where, you know, for a while I joke about this, I, I led our legal team on an interim basis, you know, between leaders. And even at the time, it was very clear that that wasn't like the best thing for, for me to be, to be doing. But it was something that needed to be done for a period of time. And I took advantage of of the opportunity to learn. I mean, just had to learn really fast. So, um, so yeah, that's how that came about.

Hey, it's Cameron Herold, founder of the Second in Command podcast. Are you a COO who's struggling to level up? Every COO or second in command should join the COO Alliance. Go check out cooalliance.com, and for just the cost of a few coffees a month, you can get world-class training, 12 monthly masterminds, and attend 2 live events a year with top COOs from around the world. The last 10 years we've been building and growing the COO Alliance to put the tools, peer support, and strategies in place to help COOs grow themselves and their companies. Backed by rave reviews from hundreds of COOs and their CEOs who've seen insane growth, we also have a 10x guarantee. It's your tribe. Go check out cooalliance.com. Sign up for a quick call to learn more. Welcome home.

What does your role look like now, day to day, when you're Sunday night, you're looking forward to the rest of the week? Do you have a planning process? Is it the same every week? Is it quite versatile? What does that look like?

Yeah, I'm chuckling because most people that know me know that I have some planning process. I am a relatively structured folks and folk, uh, person. And when I think about one of the things I, I always tell people is I live by the— I live the one calendar life. Um, I put everything on my calendar, whether it's something I need to do with the family, with the kids, with, with my wife, um, or whether it's, uh, work. Uh, and again, 80%, 90% of what's on my calendar is work stuff. But, um, but yeah, especially if it's during work hours, like it's going on my calendar so that I can I can, I can do that. So yeah, I have, I have a, I have a pretty intense planning process. It's, I guess you, there were two questions in there. It's like, what is the actual job? And then how do you plan for it? So I'll ask, I'll answer the how do you plan for it? And then we could get into what the actual job is. I do have a process. Sunday nights I generally spend, or Sunday, Sunday, whenever I sit down for the hour to 2 to 3 of, of work block time, whether that's while the kids are napping before they're awake in the morning or after they go to bed at night. I generally look at— basically, I have a Google Sheet to-do list that I prioritize, and I try to make sure there are no more than 3 priority 1 things. If I'm not saying that always happens, there are— there could be more than 3 priority 1 things, but, but I try to really figure out what is a top priority for now. And then generally that list is pretty long. It is a running list, and I kind of resort it every time I, I add things to it. And oftentimes during the week, by the way, I will be adding things to it and putting an expected priority. But what I spend Sunday night on is really looking at the thing and the priority and trying to make sure that I, I'm not in a position where I won't be impactful. I then look at my calendar and try to figure out when I am going to push those priorities