Building Solutions to Expand Healthcare Access: Q&A with the Founder of Vitable, a Citi Impact Fund Portfolio Company

In the U.S., healthcare coverage is still far from universal. Roughly 1 in 3 people with employer-sponsored health coverage say that they or a family member have skipped or delayed necessary healthcare because they can't afford it. This is due in part to the fact that over 78 million Americans are hourly wage workers, of which more than 50 million earn less than $15 per hour. Often working families can earn too much to qualify for Medicaid coverage but still cannot afford comprehensive health insurance, which typically costs hundreds of dollars each month and can involve high out-of-pocket deductibles. At the same time, their employers experience multiple pain points and questions : issues with recruitment and retention of employees, absenteeism due to illness or doctor visits, and compliance with state and federal laws.

As part of the Citi Impact Fund's mission to invest in high impact, innovative solutions to address pressing challenges for underserved communities we look for ways to expand access to health, particularly for low-income households. Often the innovation we see is targeted at Medicare or large employers. However, more than 50 million Americans work in small businesses and may not benefit from the healthcare innovation we see in the market today. We are excited to invest in Vitable and support the continued growth of their direct primary care model that is designed to expand access to healthcare for hourly wage workers. I sat down with Vitable CEO Joseph Kitonga to discuss the company's innovative approach and his founder journey.

Joseph Kitonga, 27, founded Vitable to address the disparity in access to healthcare by providing high-quality in-person and virtual primary care to small employers of hourly workers. Kitonga is a former Thiel Fellow, Forbes 30 Under 30 honoree, and Y Combinator alum.

Ryan Alam: How is Vitable developing solutions to expand access to healthcare to underserved populations?

Joseph Kitonga: Vitable is a direct primary care plan focused on the employers of blue-collar or hourly employees. We use a hybrid model to combine virtual visits with in-home or workplace pop-up visits, providing quality coverage at a low cost to employees. The inspiration for Vitable, and who you could think of as our typical customer, is my mom. She ran a senior care agency with about 200 caregiver employees who made too much to qualify for government-sponsored healthcare or Medicaid, but too little to afford comprehensive commercial health insurance. They were either uninsured or underinsured and over-utilizing the emergency room, where upwards of 70% of visits are unnecessary and cost an average of around $2,400 per visit. This cost burden makes upward mobility difficult and generally leads to worse health outcomes.

What makes Vitable different from many digital health companies is that we started with a focus on small business and hourly employees and our solutions remain tailored to their unique needs. Our hybrid model is relatively inexpensive and allows us to share savings with our members. For example, we offer over 1,000 prescriptions, the most common lab tests, a mental health program, and the ability for employees to add their families to the plan, all at no additional cost. The "how we do it" is important, but it is secondary to "who we do it for."

Ryan Alam: Why did you become an entrepreneur?

Joseph Kitonga: My family immigrated from Kenya to the U.S. when I was 13 years old and I had the privilege of watching my mom and dad - who had formerly been teachers - start their small business senior care agency, watching them grow from zero to a few hundred employees. Before Vitable, I was studying computer engineering and I had spent three summers interning for a large technology company while I was in college. During those months, I would have a zero-copay health plan and a nearby clinic. It was incredible! Then I would return home and my parents and their caregivers couldn't afford to have any healthcare plan at all. I felt like there was a huge disconnect.

I also learned that in two Philadelphia zip codes just 5 miles apart, the average life expectancy was different by 20 years and a contributing factor was a difference in access to high-quality primary care. This felt like my calling and a problem that I could dedicate the rest of my career to solving, so I dropped out of college to work on it. At the time we had one client, impacting fewer than 30 lives. But I knew from our very first member who joined Vitable that this was a huge enough problem that if I could find a way to get efficient distribution I could both build a viable business and impact many lives. Today, we work with more than 400 companies, impacting over 50,000 lives.

Ryan Alam: What are some of your biggest learnings to date from building Vitable?

Joseph Kitonga: I think the biggest learning is that there's no shortcut for developing empathy with the people you're building solutions for. It takes real work to build deep empathy, but any time we've tried to be visionaries about how the world should work it almost never worked. Instead, we must focus on who we are building for, what they care about and what their needs are.

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