Karl Ronn of First Mile Care: “Sleep is also critical to wellness, and something our coaches touch upon in multiple sessions”

Sleep is also critical to wellness, and something our coaches touch upon in multiple sessions. It’s not enough to get the right quantity of sleep; you need good quality of sleep. Coach Karalyn Cass points out the powerful connection between sleep and weight gain and loss. Sleep affects two hormones which tell your body when […]

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Sleep is also critical to wellness, and something our coaches touch upon in multiple sessions. It’s not enough to get the right quantity of sleep; you need good quality of sleep. Coach Karalyn Cass points out the powerful connection between sleep and weight gain and loss. Sleep affects two hormones which tell your body when you’re hungry and when you’re full. Sleep deprivation also affects how your body reacts to insulin. If you release less insulin, you’ll have a higher-than-normal blood sugar level which will increase your risk for diabetes.

Often when we refer to wellness, we assume that we are talking about physical wellbeing. But one can be physically very healthy but still be unwell, emotionally or mentally. What are the steps we can take to cultivate optimal wellness in all areas of our life; to develop Mental, Physical, Emotional, & Spiritual Wellbeing?

As a part of our series about “How We Can Do To Cultivate Our Mental, Physical, Emotional, & Spiritual Wellbeing”, I had the pleasure of interviewing Karl Ronn, founder and CEO of First Mile Care, a Silicon-Valley based preventative chronic care company that develops affordable, scalable, and sustainable solutions to reverse health conditions like prediabetes..

Ronn spent nearly 30 years with Procter & Gamble, winding up as vice president of R&D and general manager of new business/health care, where he was responsible for developing P&G’s capability to deliver disruptive innovations. Ronn developed new markets for household-name cleaning products like Febreze, Swiffer and Mr. Clean Magic Eraser, as well as personal care products like Old Spice and Secret. Since leaving P&G in 2010, Ronn has founded multiple startups and consulted with Fortune 500 companies wanting to create billion-dollar growth engines. Ronn has also sat on the advisory board for the Johns Hopkins School of Public Health for the last 15 years. He leverages his expertise in consumer marketing, demand creation and behavioral change, most recently to establish best practices in preventing chronic illnesses like diabetes.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

While I live in the San Francisco Bay Area, I grew up in Ohio, where I graduated from the University of Toledo with a Bachelor of Science degree in chemical engineering. There are actually two of me as I’m an identical twin. My brother now lives in Atlanta. We never played tricks on people, yet every so often when I’m in an airport or at a large meeting, people call out my brother’s name and start talking to me. I freak them out when they realize the error. It’s great to have him provide a second perspective on life milestones and other things as we are both experiencing them in the same way, not as older or younger brother, but more collaboratively.

What or who inspired you to pursue your career? We’d love to hear the story.

Currently, I am the CEO of First Mile Care, a Silicon-Valley based preventative chronic care company. I founded First Mile Care in 2018 with support from Health2047, the Silicon Valley innovation subsidiary of the American Medical Association (AMA). We develop affordable, scalable, and sustainable solutions to reverse health conditions such as prediabetes. The First Mile platform enables personalized support and guidance at the community level, giving people access to the coaching, tools, and resources they need to live better, healthier lives.

I got the inspiration to start First Mile Care from Dr. Karen Kmetik, the AMA’s group vice president for health outcomes. She talked to me about the National Diabetes Prevention Program (DPP) created in 2010 by the Centers for Disease Control as a partnership of public and private organizations working to prevent or delay prediabetes and type 2 diabetes. There are currently 88 million American adults — one in three — with prediabetes. That’s up from 84 million a couple of years ago. Despite the DPP being covered by Medicare, Medicaid, and most major health insurance providers, barely 500,000 people have gone through the program as of the end of 2020.

I told Karen, you should target getting half those people in the market within 10 years, and work on the barriers to getting there. About three months later, I called her back and told her that if she was really serious about wanting to do it, we should form a company. And so her problem was the inspiration for First Mile Care and our current focus on diabetes prevention.

Partnering with physicians, First Mile Care recruits experienced wellness coaches with local ZIP-code knowledge and trains them in the DPP, a year-long lifestyle change program clinically proven to reduce risk of developing type 2 by 58% (and 71% for age 60+). Coaches counsel participants on healthy practices and personal action planning, both one-on-one and in group settings within 10 minutes of their homes. (The First Mile Care name came from the insight that you live your life mostly within the first mile of your home.) The focus is on creating small, sustainable habit changes, covering not just eating and meal planning, but fitness, stress management, mindfulness, triggers, and motivation.

None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?

In addition to Dr. Karen Kmetik, the AMA’s group vice president for health outcomes, another person who has been very influential on the creation of First Mile Care has been Dr. Ann Albright at the Center for Disease Control (CDC), as she is the director of the CDC’s division of diabetes translation.

On a personal level, though, throughout my life, there has been a small group of people to whom I could turn for their thoughts on what I should do next. These have been family, friends, bosses, and long-term business acquaintances. Their collective voices have helped me understand where to spend my time to make the biggest difference. They don’t always have the same point of view, but over time, their advice leads to clear choices.

I’m not originally a health care industry expert but more of a consumer products person. When the opportunity came to lead health care businesses at P&G, my panel of advisors told me to definitely go do it, focusing on transformation, as the “voice of the patient” is strengthened by technology. Ultimately, that experience of listening to experts in health care and then finding a way to help people get their needs met leads directly to the First Mile Care business. The industry uses the term “self-care” to describe when care happens outside of the medical facility. I prefer “personal care,” which is what we call our life’s daily routine.

First Mile Care works to connect people who live in the same neighborhood and allow them to learn from each other, facilitated by a coach. They get the information they need, but ultimately build bonds with others on the same journey to creating a healthier lifestyle. What I know from managing personal care brands like Secret and Old Spice, is that we take care of ourselves out of care for others. Great personal care is not about beauty, it’s about connection. Self-care can be too lonely and judgmental of a term. Personal care is what I do for you, more purpose-driven.

Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?

A secret to success is empathy — designing for someone else, not yourself. When I was at Procter & Gamble, I helped with developing Always Plus, the initial feminine hygiene maxi pad with “wings.” As part of the development process, women had to tell me, a guy, who clearly couldn’t use the product, the truth about what they needed in the product. I would partner with a woman from the Always business to interview a maxi pad user. My partner would start the interview and you could tell the interviewee was thinking “What is he doing here?” After we got going, I’d introduce myself and say, “My job is to make a better maxi pad. Clearly I’m going to fail unless you help me.” The interview conducted by a woman and a man together was much more successful because when we got to a difficult subject, the interviewee would say, “Well, you know,” while looking at my partner. I could say, “Well, sadly I don’t know. Could you help me?” This collaboration of expert and novice is key to learning, even if outside the comfort zone of the participants.

Staying humble and asking for help allows faster and deeper learning. First Mile Care is a startup trying to break through to help 88 million people prevent diabetes. There isn’t a simple answer. We are a learning company. We listen to people’s experiences and determine what to try to do that would help, then try it with them, and if it helps, do it again. If it doesn’t help them, it is learning, not failure.

Is there a particular book that made a significant impact on you? Can you share a story or explain why it resonated with you so much?

The Innovator’s Dilemma” by Clayton M. Christensen, published in 1997. This was the first book to describe disruption versus sustaining businesses. Most business is optimizing the present market by incrementally improving products and services. This is good, but over time you are making changes that don’t really add value; they simply defend your market share. Christensen set in motion the rules for creating totally new businesses, real game changers. It wasn’t random; it was just a different process. This resonated with me. The billion-dollar businesses I worked on needed the steady improvements, but there was more we could do to tackle bigger problems.

I was fortunate to get to know Clay and to work with his Innosight innovation consulting firm. This framework provided the rigor needed to create new P&G businesses like Swiffer, Febreze, and Mr. Clean Magic Eraser. This honed my skills to take on transformation in health care, directly leading to the founding of First Mile Care.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

“If you can’t fix it, feature it” is one of the lessons that I use very often. When we try to do something and it doesn’t work, we go back and try again. That’s fine, but after trying it a number of times, you have to try something else. The real currency is time, not money. “Featuring it” means to embrace what you are seeing and design around it instead.

The CDC-backed Diabetes Prevention Program works. The problem is that the DPP isn’t yet reaching millions of people. Everyone wants to tackle these problems digitally because that’s the new technology. At First Mile Care, we are embracing the opposite. We said, let’s be hyper-local, with an in-person, face-to-face program in every ZIP code. Embrace the complexity and find a solution. We are proving that our platform can do that.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

We currently offer First Mile Care diabetes prevention programs in the San Francisco Bay Area and Greater Houston, which has a much larger diabetes challenge than the Bay Area. We’re also coordinating now with a very large health system in a Midwestern state, and a national system that’s in more than 20 states. The reason we’re adding health systems is because they represent so many physicians. We’re also expanding in partnership with Federally Qualified Health Centers (FQHCs) to better reach populations and neighborhoods in metro areas underserved for health care options.

Our coaches lead classes in English and Spanish, but are looking to add Vietnamese and Cantonese Chinese along with other languages. Each language reflects different cultures, foods, and traditions, so it’s important to establish a strong local capability and then expand it out. We’re also seeing success in recruiting more men into the program, which is important since they are at higher risk for developing diabetes. The probability of developing diabetes increases with age, so we’re also trying to lower our median participant age to reach people at an earlier life stage.

OK, thank you for all of that. Let’s now shift to the core focus of our interview. In this interview series we’d like to discuss cultivating wellness habits in four areas of our lives, Mental wellness, Physical wellness, Emotional wellness, & Spiritual wellness. Let’s dive deeper into these together. Based on your research or experience, can you share with our readers three good habits that can lead to optimum mental wellness? Please share a story or example for each.

The First Mile Care Diabetes Prevention Program curriculum recognizes that developing a healthy lifestyle is about more than just eating. Our coaches look at fitness, stress management, and mindfulness as well. For example, Coach Karalyn Cass recently led a webinar which looked at how you can maintain a healthy brain as you age. You experience gradual changes to your brain just like the rest of your body. It shrinks in size, it slows down, and becomes less adaptive to change. However, there are some things you can do to combat that through regular exercise; healthy eating; maintaining social connections even if they’re via Facebook or Zoom; reading and writing; sleeping and stress management; art, music and animal therapy; and constantly stimulating and challenging your brain by learning new things, whether languages, skills, crafts, or other hobbies. Train and sharpen your brain through word and number puzzles and games that require concentration, memory and problem solving.

Do you have a specific type of meditation practice or Yoga practice that you have found helpful? We’d love to hear about it.

I frequently go on long walks in the Baylands Nature Preserve near Palo Alto, a large tract of undeveloped marshland adjacent to San Francisco Bay and not far from my home and office. The subtle change in the birds, sun, and wind are both calming and reenergizing.

Thank you for that. Can you share three good habits that can lead to optimum physical wellness? Please share a story or example for each.

We emphasize at First Mile Care that the ultimate goal of the Diabetes Prevention Program isn’t weight loss. It’s disease prevention. The DPP requires increased activity and a target of 5% weight loss. Over-focusing on just weight loss can be a trap for getting caught up in body image, so we work to correct that understanding.

Exercise is a key component in helping your body control its blood sugar level and insulin sensitivity which can lead to a chronic illness like diabetes. (And keep in mind that people with chronic illnesses are at greater risk of severe complications and/or death from COVID-19.) Physical activity for a minimum of 150 minutes a week is a core principle of First Mile Care and the DPP. We encourage 30 minutes a day, ideally, but as our Coach Shavon LeBlanc points out, you need to consider the frequency, intensity, amount of time, and the type of physical activity. You can do longer activities, like a 30-minute walk, and schedule it three times a week. Or you can choose shorter intermittent activities, like 10-minute strength-building exercises, and do them three times a day. And obviously the type of exercise — cardiovascular exercise, resistance training, stretching, yoga, etc. — allows for a different level of intensity and length of time. Pick the activity and the structure that works best for you. The important thing is to find a combination of physical activities that you enjoy doing and make movement a priority multiple times a day.

Sleep is also critical to wellness, and something our coaches touch upon in multiple sessions. It’s not enough to get the right quantity of sleep; you need good quality of sleep. Coach Karalyn Cass points out the powerful connection between sleep and weight gain and loss. Sleep affects two hormones which tell your body when you’re hungry and when you’re full. Sleep deprivation also affects how your body reacts to insulin. If you release less insulin, you’ll have a higher-than-normal blood sugar level which will increase your risk for diabetes.

We also try to offer practical advice in First Mile Care coaching sessions, such as how to shop for healthy food, how to prepare healthy meals with pantry staples, and how to plan meals several days in advance. For many people, planning meals is a challenge because of needing to decide days in advance what to eat, the time commitment in developing menus, and estimating how much food to buy and make. Our licensed nutritionist coaches like Coach Irazema Garcia advocate doing most of the prep in advance as it’s then easier to be more aware of what you eat, and to control how much.

Do you have any particular thoughts about healthy eating? We all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

It takes time to make healthy lifestyle changes permanent and over-focusing on just weight loss can be a trap, so we work to correct that understanding. You have to be able to alter the cues, triggers, and rewards for your behaviors. You can’t make a big change in a short time as the habits won’t stick. That’s why the Diabetes Prevention Program works, as it offers coaching with a peer group and 12 months of personal action planning along all the dimensions required for success.

Diabetes is preventable and most people don’t know that. They may be trying to lose weight, but this can be a focus on image versus health. The year-long DPP is clinically proven to reduce risk of developing type 2 by 58% (and 71% for age 60+). It requires increased activity and a target of 5% weight loss. These things produce changes in the serum levels and reduce blood sugar levels. One of the most important things is to use the year of the program to reinforce the steps to disease prevention and produce successful improvement in health.

Can you share three good habits that can lead to optimum emotional wellness? Please share a story or example for each.

It’s important to address the behavioral triggers that can get in the way of changing habits to optimize wellbeing. There are three parts to a trigger — the cue, the routine, and the reward. If you’re able to identify your triggers and change the unhealthy pattern, then you’ll be able to make positive lifestyle changes that can endure. It could be something as simple as realizing that you automatically grab a sugary soda from the fridge when your sister phones you for a catch-up session, and substituting a healthier drink or snack.

In First Mile Care DPP coaching sessions, we often discuss the link between stress and unhealthy eating habits that can lead to prediabetes. As our Coach Jenny Fowler explains, when you get into a situation that produces stress, your adrenaline kicks in and your heart rate increases and your blood pressure rises. When you’re experiencing ongoing stress and high levels of adrenaline, your body is programmed to want more food, especially something sugary with extra glucose for quick energy to deal with the adrenaline boost. Our coaches help our DPP participants figure out how to calm themselves with enjoyable activities that help them to relax and free their minds of negative thoughts and energy — and substitute new rewards for the snacks in the fridge they might otherwise have grabbed.

We encourage DPP participants to practice mindful eating, as the close connection between your stomach and your brain can be influenced through mindfulness techniques. Mindful eating is learning to listen to your body’s natural hunger cues so that you eat when you experience true, physical hunger and not just the hunger that originates in your head due to your emotional state. Our Coaches Kathy Gregory and Karalyn Cass, for example, have guided DPP participants through a series of questions to gauge if they’re eating emotionally or eating mindfully. One helpful practice for learning to eat mindfully is to keep a food journal that can connect the dots between your food and your mood. You track details about your meals and snacking such as the time of day, where you are, who you’re eating with, how hungry you are, and how quickly you become full. The food journal can reveal trends and patterns in your eating habits which will help you to evaluate your behaviors and set reachable goals for changing them.

Do you have any particular thoughts about the power of smiling to improve emotional wellness? We’d love to hear it.

Smiling is literally a positive response to another person and has a physical effect on mood. A nice thought can cause the brain to produce hormones and neurotransmitters like serotonin and endorphins that lift your spirt and promote feelings of happiness, which are then mirrored by other people when you smile.

Finally, can you share three good habits that can lead to optimum spiritual wellness? Please share a story or example for each.

I think if you can find a healthy balance of the main things in your life that contribute to feelings of joy and satisfaction, you’ll find spiritual wellness. These can include health, physical activity, nourishment, home environment, relationships and social life, creativity, finances, career, education, etc. But that’s a tough challenge!

Our First Mile Care Coach Kathy Gregory led a session on healthy balance in which she recommended you choose one to three areas in your life in which you would like to see changes this year, and determine what empowerment and planning strategies need to be in place in order for you to succeed. Create an action plan, and make sure you make regular space in your schedule for working towards your goals. Oftentimes, in the areas where you’re struggling, you may not be spending as much time and energy as you need to achieve success as it’s easy to skip things if they haven’t a dedicated slot on your calendar. First Mile Care also believes community support is one of the most powerful success motivators, so sharing your goals with a friend or a family member (or other DPP group participant) will help keep you accountable towards your goals.

If the stress of these crazy pandemic years is getting to you, you can bring down your anxiety levels through coping strategies such as exercise and calming techniques like meditation and mindfulness. And always remember that success for you doesn’t look like success for other people. Don’t measure by other people but decide what success feels like for you.

Do you have any particular thoughts about how being “in nature” can help us to cultivate spiritual wellness?

As I said above, I like to take long walks along the San Francisco Bay in the marshlands of the Palo Alto Baylands Nature Preserve. I find that experiencing the rhythm of the seasons, noticing the subtle changes in air temperature, listening to the lapping of the water against the shore, marking the comings and goings of the birds, is highly soothing. It reminds me that there are certain fixed events that happen no matter how many other changes are taking place around me.

Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

First Mile Care is already here to help solve one of the biggest problems facing America. Diabetes is preventable but we’re not preventing it enough. There are 30 million Americans with diabetes and the U.S. spends more than 300 billion dollars a year on the disease (even ignoring the personal issues with managing the illness). We can’t let the other 88 million adults with prediabetes progress to diabetes when there is a proven way to stop it. That number has increased in the last few years despite the popularity of wearable fitness trackers and wellness apps. We have mountains of body data available, but that’s not making us healthier. In spite of our best efforts, diabetes is winning.

At First Mile Care, we know the value of a primary care physician’s strong recommendation. That’s why we work on behalf of the physician to offer the program. We know that about 15% of all people with prediabetes will take the program when we offer it. That’s 13 million people who are ready now, yet only 500,000 have taken the program since inception. Our goal is to get that first 15% into a program and then continue to get the next group as they become ready to take action.

But a physician can’t recommend something that isn’t available in their community. So First Mile Care works to generate the demand for the program and match it instantly with the supply. Our goal is to be an extension of the physician’s practice and enable them to do the high touch needed to help prevent diabetes among their patients. This means diabetes prevention programs that are organized around ZIP codes to be available within 10 minutes of a participant’s home and at convenient times when they can attend. We build out that capacity for the physician, do all the education and recruit for them, hire experienced local coaches and train them in the DPP, run the programs, and keep the physician in the loop on their patient’s progress. First Mile Care acts as an extension of their practice designed to deliver prevention.

With COVID-19 spotlighting the vulnerability of people with comorbidities like diabetes, we know there’s a lot of interest in the DPP once people become aware it’s available to them in their neighborhood, that it’s convenient, and if they get that recommendation from an authority figure like their doctor.

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂

Oprah Winfrey. She has a deep understanding of what it takes to make a life change and the ability to connect with people of all types. The First Mile Care Diabetes Prevention Program isn’t a weight loss program; it is a disease prevention program. The DPP is clinically proven effective by the CDC. This message needs to be heard. When weight loss becomes the goal, it can risk being a short-term, yo-yo goal or gets associated with body image. Small changes that fit into your life can change your health and prevent diabetes. Oprah’s voice could help make this a movement. Oprah, are you listening?

How can our readers further follow your work online?

Website: https://firstmilecare.com/

Twitter: https://twitter.com/first_mile_care

LinkedIn: https://www.linkedin.com/company/first-mile-care/

LinkedIn: https://www.linkedin.com/in/karlronn/

I also co-authored “The Reciprocity Advantage,” a book on the disruption into business through partnerships. You can find more information on it at https://www.reciprocityadvantage.com/

Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.

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