#02 - Season Health

How Season Health is building a turn-key "food-as-medicine" platform for payers and providers

August 03, 2023

Chronic disease is one of the biggest health issues facing the world today.

In the US alone, 11.3% of adults have been diagnosed as having type 2 diabetes, and an additional 38% are pre-diabetic. Chronic diseases such as type 2 diabetes, heart disease, and kidney disease amount to well over a $500 billion in US health care spending each year, placing a tremendous financial burden on both individuals and insurance payers.

While many drugs and surgeries have been developed as solutions, everyone recognizes that reactive treatments alone will not end this epidemic. Nutrition, fitness, and lifestyle interventions are seen as the best approach to preventing and healing these diseases in the first place, but getting patients access to healthy food, education, and guidance is difficult.

This is where Season Health comes in.

Season Health is a "food-as-medicine" platform that helps people with chronic conditions to improve their outcomes through healthy food and meal delivery, and tailored nutritional guidance.

Today, we'll dive into Season Health, and learn more about:

  • The surprising discovery the led to its founding

  • How Season is helping patients with chronic conditions get access to healthy food

  • The Season Health patient experience

  • Clinical outcomes of patients using Season Health

  • The "food-as-medicine" startup landscape

And more.

How one startup led to another: The story of Plated and its users "accidentally" becoming healthier

After graduating from Harvard Business School, Josh Hix set out to build his own company with co-founder and former classmate Nick Taranto.

In 2012, the two started Plated, a service that delivered meal kits complete with ingredients and recipes. After several years, Plated would raise over $50 million in venture funding, generate over $100 million in annual revenue, and even make an appearance on Shark Tank.

The business was humming along, seeing success as a DTC meal kit for people looking for an easy at-home cooking experience. And then all of a sudden, Josh received some interesting news. A health insurance payer reached out to let him know that a number of patients on their plan were reporting that they were getting healthier from using Plated's meal kits.

Whether it was lower blood sugar, a slimmer waist, or few less pounds, Plated users were improving their health, and the only thing they could attribute it to when talking to their doctors was the use of Plated. This caught the attention of the insurance company for a number of reasons, but the biggest was the fact that it's hard to get people to eat healthy. And yet, these patients had seemingly changed their eating behavior accidentally. Without intending to, Plated's meal kits had solved two of the biggest problems facing health insurance companies: Making people healthier and driving down their cost of coverage.

Josh and Nick engaged in partnership talks with the payer, with the ultimate goal of scaling the meal service as a benefit for plan members that would hopefully make them healthier and cheaper to cover. But after some talks and research between the two parties, the idea was shelved, and Josh went back to focusing on the core business of Plated.

Still, the idea resonated with him. It was something he wanted Plated to pursue, but at the time he, nor anyone at the company, had the knowledge and expertise to partner with a health plan. Plated was acquired by Albertsons in 2017, and Josh would stay on for a few more years as part of the team, but the idea to partner with health plans was still on his mind.

Josh left Albertsons in 2019, but it wouldn't be long after until he had the time, opportunity, and expertise he needed to build a meal kit service that capitalized on what insurance payers had tried to start with Plated.

The Founding of Season Health

After leaving Albertsons, Josh spent time developing the idea that would become Season Health.

Josh knew he needed a cofounder with expertise in digital health. He connected with Mustafa Shabib, who had previously been the founding CTO of Quartet Health, and the two became co-founders. Around this time, Dr. Andrea Feinberg also joined in as an advisor. She had founded and led the Geisenger Fresh Food Farmcy as Chief Health Officer, and provided Josh and Mustafa with guidance on working with health plans and delivering "food-as-medicine".

Together, the three combined their experiences in consumer food delivery, growing and scaling a digital health startup, and the clinical use of nutrition to form Season Health.

The Season Solution: Food Access, Education, and Guidance

Season helps patients with chronic conditions get access to healthy food, nutrition education, and professional guidance to improve their outcomes.

While this may sound simple, it is actually anything but. Primary care physicians don't have the time or training to provide ongoing guidance when it comes to nutrition. And even when they can, many patients with chronic conditions struggle to get access to healthy food, for reasons of both cost and availability. It's estimated that 23.5 million people in the US live in what are known as food deserts, areas where it is difficult to find or afford access to nutritious food. Taken altogether, patients with chronic disease have little support when it comes to eating healthy.

Season recognizes this, and it's the main problem that they're solving for.

In an interview with Fitt Insider, Josh describes what Season as doing as, "trying to institutionalize nutrition into healthcare in a certain sense". For physicians, Season is a "software platform to let them formally prescribe nutrition", and for the patient, it is a, "consumer-grade app to actually fulfill that prescription."

Embedding food-as-medicine into healthcare is a challenge in and of itself, however. Getting buy in from insurance payers to reimburse any new solution is difficult, and it's why Season has started by supporting two of the most expensive nutrition-sensitive conditions, type 2 diabetes and high-risk pregnancy. By showing they can reduce the risk and cost of these patients by improving their health, Season has been able to get payers and physicians to adopt  their solution.

The Nutrition Prescription

For patients using Season Health, everything starts with the Nutrition Prescription.

The Nutrition Prescription is issued by a patients physician who is on a health plan that supports Season. The prescription is sent to the patient's email, and outlines what Season Health is, why it's beneficial for their condition, and how to sign up.

Patients can also sign up on their own through Season's app or website. Through the sign up process or after speaking with one of Season's Dietitians, they'll learn if they are eligible for Season.

As of August 2023, Season opened eligibility for anyone with type 2 diabetes and/or high-risk pregnancy who lives in the lower 48 US states (with the exception of New York). The cost of membership, which is $75/month, is then covered completely or partially by their health insurance provider, but can also be paid out of pocket.

The Patient Experience

The patient journey starts on Season's mobile app.

Onboarding starts with a consultations with a Registered Dietitian. The RD is there to help patients learn about nutrition, set goals, and provide guidance throughout the program. Patients meet with their RD 1-2 times per month over video chat, but can also communicate with them over text in between sessions.

The rest of the app experience has been designed to support patients in every facet of their journey, from nutrition education and goal tracking, to grocery delivery and budgeting tools.

Meal recommendations are based on a patient's condition, but they also have flexibility over what they choose to eat. Patients can set dietary restrictions, such as avoiding allergens or animal products. Season also takes into account cultural background, so that they can recommend meals that patients are most comfortable with. The app also asks the patient how many people are in the household and what cooking equipment is available, so that meals can be tailored to accommodate a variety of situations.

When it comes to getting the food, patients have two options. They can shop for groceries through the app, which Season helps choose based on the patient's diet, or they can order ready-made meals. Whether a patient chooses groceries or meals, both have options for home-delivery. Groceries and meals are not included in the $75 monthly membership cost for Season, but depending on the patient's health plan, food costs may be completely or partially covered.

To tackle the problem of lack of healthy food availability, Season is leveraging existing meal delivery solutions to get food to patients. Season has a partnership with Instacart, which allows patients to get their grocery order delivered, and depending on their health plan, get reimbursement for all or some of the cost.

Once groceries have been delivered to a Season patient, they can choose any number of healthy recipes provided in the app to cook a meal that supports their condition. Recipes are curated for patients based on their eating preferences, condition, available time and cooking equipment, and budget.

But if a patient doesn't want to, or cannot cook for themselves, meal delivery is an option. Season has partnered with Territory, a healthy meal delivery service, to provide ready-made meals to patients that support their condition and fit their budget.

Zooming out, what Season ultimately helps patients do is change their food environment, to one where healthy food is accessible, and support only a few taps away.

This change in environment is upstream of positive changes in health outcomes. By creating a holistic system around the patient that not only gets them access to healthy food, but does so in a way that's affordable, supportive, and empowering, Season has turned eating healthy into a wonderful user experience.

Aligning Incentives: Why insurance payers are willing to pay for Season Health

Season exists to make people's lives healthier. This is their mission, and for Josh Hix, Mustafa Shabib, and the team at Season, success means helping people with chronic conditions to improve their lives through the power of nutrition.

But if that mission is going to scale, someone needs to pay for it. This is where the relationship with insurance payers comes in, and its's why aligning incentives--making patients healthier and cheaper to cover--is so important for Season to demonstrate its ability to do.

This is the "strange and weird world of healthcare", as Josh Hix puts it, telling Joe Vennare of Fitt Insider, "You have a customer and multiple users, and sometimes it's not clear who is who, but the insurance plan is the customer, or whoever the risk-bearing entity is, and we're just here to make people healthy."

Season has chosen to serve type 2 diabetes and pregnancy first because these patients are high-risk to the payer, but become much lower risk when they're on top of their nutrition. By making patients with these conditions healthier and lower-risk for the payer, the likelihood of reimbursement for Season's solution goes up.

Payers are paying attention. They understand that nutrition, when used properly in the care plan, can lead to significant savings.

In a 2022 study that looked at potential changes in health care spending and hospitalizations after the coverage of specially designed meals for patients with chronic conditions on Medicaid, Medicare, or private insurance, researchers found that payers could save $13.6 billion annually, and 1.6 million hospital visits could be avoided.

Geisinger's Fresh Food Farmacy, the program Dr. Andrea Feinberg had founded and led, showed in 2018 just how clinically efficacious and cost-effective providing healthy food and guidance to chronic disease patients can be. 95 adults with type 2 diabetes and who were food insecure were given fresh fruits and vegetables, lean meats, and whole grains for them and their family, enough for two meals a day, five days per week. At the end of the 18-month pilot program, patients saw their HbA1c levels drop by 17.8%, and overall their risk of death decreased by 40%. This was accompanied by an 80% drop in average annual costs to cover these patients, going from $240,000 to $48,000 annually per member.

Nutritious food is making chronic disease patients healthier and lower risk. By partnering with Season, payers get access to a turn-key "food-as-medicine" platform that they can deploy to its members, and know that they're offering a holistic solution. Season currently has partnerships with Geisinger, CommonSpirit Health, Cricket Health, and Medicare through healthAlign.

Key metrics and clinical outcomes

Season used a large part of the venture funding they've received to conduct clinical trials in chronic disease patients.

In partnership with CommonSpirt Health, Season is conducting clinical trials with their diabetes patients. The trial looked at the efficacy of Season to manage diabetes care, specifically kidney disease precipitated by diabetes.

Season has also published their own case studies, which show significant results. In a 3 month trial with Medicaid patients in 2022, patients saw an average drop in their HbA1c of 1.4 points, and a 2.7% decrease in BMI. A second case study, this time in diabetes patients, showed similar drops in A1c after 90 days.

Funding

To date, Season Health has raised just over $36 million in funding.

They've been backed by some big names, including a Series A led by a16z, which was followed on by 8VC, LRV Health, and Company Ventures. Angel investors, including Toyin Ajayi, the CEO of Cityblock, and Joey Grassia, and Max Mullen and Brandon Leonardo, the co-founders of Instacart.

Julie Yoo, a General Partner at a16z, pointed to the many problems that our healthcare system has when it comes to promoting food-as-medicine, in a piece she wrote after leading Season's Series A:

"In many ways, our healthcare system is still in the “read-only” era of food-as-medicine – we can readily shop and receive advice for better dietary choices from our doctors, dieticians, health coaches, and even the NYTimes Cooking app, but translating that advice into actual healthy food showing up on our dining tables is still a disjunct, highly manual, and costly process."

Season solves all of these problems, in a way that is appealing to patients, providers, clinicians, and investors alike.

The landscape of food-as-medicine startups

Season isn't alone on their mission to make food-as-medicine more accessible.

Companies such as NourishedRx and Free From Market are packaging personalized nutrition, clinical guidance, and patient education together on their own platforms. Both companies have had success partnering with healthcare payers, and have drawn funding from venture capital firms.

Established food delivery companies are also getting involved. In 2022, Instacart introduced Instacart Health, a program with the goal of helping more people get access to healthy grocery items. The program partners with insurance companies, organizations, and nonprofits to provide the people they serve and employ with healthier food options. It also introduced a host of new products, such as Care Carts, which enable healthcare providers and caregivers to order groceries on behalf of someone else, and Fresh Funds, which allows organizations to give people funds to buy nutritious foods through Instacart. In more recent news, Instacart Health announced a partnership with Boston Children's Hospital in March of this year, which will focus on providing medically tailored meals.

Uber has even stepped in. With Uber Health, the company's non-emergency medical transportation and prescription delivery platform, patients of health insurance partners can get groceries delivered that are part of their care plan. The initiative is meant to help insurance payer and provider partners improve their value-based care models and population health programs.

Money is continuing to flow into the food-as-medicine scene, and it will be interesting to cover going forward. Three other startups providing medically-tailored meals, including ModifyHealth, bitewell, and Vitabowl have all raised several million in venture funding in the last year.

Looking Ahead

Even though there are a number of players in the food-as-medicine space, it's difficult to call them "competitors".

While many of these companies will be vying for partnerships with insurance payers, investment from venture capital firms, and trust with physicians and patients, they all ultimately seek to accomplish the same goal: making it easier for people to eat healthier, improve their conditions, and live better lives.

The fact that there are more startups, and some large companies, trying to do this at the same time is a good thing. It means more choice for payers, physicians, and patients, as well as reduced costs. As these companies continue push food-as-medicine into the main stream, it becomes more likely that we'll see nutrition become a focal point in our healthcare system.

Look out for more coverage on companies in this space in the near future!

Job Board

For each post, I've decided to add a job board for the company or venture firm that I'm covering. If you'd be interested in seeing a job board like this in one central place, where I can update it with open roles for all the companies I've covered, let me know in the comments.

Open Roles at Season Health

As of 2023-08-02: