This week we announced that Thomas Van Gilder, MD, JD, MPH has joined BetterUp as our first Chief Medical Officer. Coming to us from his role as Chief Medical Officer for Walmart, he has also served as Chief Medical Officer at Humana’s Transcend Insights, National Medical Director for Wellness at Humana, Medical Director for Quality Initiatives at QuadMed, and senior medical epidemiologist with the US Centers for Disease Control and Prevention.
Earlier this week, I had the privilege to sit down with Tom to talk about his career and what led him to BetterUp.
The following interview has been edited for clarity and length.
MW: First of all, welcome! When people of your caliber find us, or we find you, we feel pretty positive that the need we see out there is resonating with others.
One thing that stood out to me, in addition to your impressive credentials, is that you've also had a pretty varied career. I was wondering if you'd talk a bit about how your experiences led you here.
TVG: It's funny, whenever I'm rewriting my bio I can see how varied it looks, but for me, it was always very purposeful. The common thread has always been: how can I be in service of reaching the greatest number of people, or affecting the greatest change?
I started off in internal medicine, and within my residency, got into community health and primary care. That led me to develop an early interest in public health and epidemiology. We kept seeing these health issues coming into the clinic, and I started thinking about, is there something we can do to keep them from coming in? Instead of just treating them, could we get more at the root causes of these issues?
That led to my time at CDC, again, looking at ways of understanding and having the greatest impact possible on public health. I recognized that public policy and even law was a major shaper of public health and could be a lever to improve it.
I went from there into trying to apply those principles, first through primary care transformation. How do we do a better job at equipping primary care providers with better technology and information to take better care, not only of individual patients, but of their whole patient panel — the people around them? I was also working with the physicians and other clinicians to make sure that what they're providing meets both the needs and the kind of financial arrangements that individual health plan recipients have. I saw it as another, larger, platform to try to bring about health improvements on a population level.
When I was approached by Walmart to help with their health strategy and new offerings, I really had no idea how enormous it was. You know, 90% of the US population lives within 10 miles of a Walmart, and about 150 million people go through a Walmart somewhere in the country every week. The thought of being able to bring healthcare affordably and locally to that size of population is really exciting. And we focused our efforts on making sure that we built something comprehensive, affordable, and different enough to get people interested in joining us and building those clinics.
MW: In your LI post last week, you wrote:
“I have spent the bulk of my career misunderstanding one of the core elements of everything I have tried to do. From clinical care to clinic design, from public health to wellness, from health plan operations to healthcare technology, behavior change is at the core of success. Engaging in or guiding behavior change is hard work, and most of us don’t have access to relatable, reliable guides. We need help.”
How did you come to focus on behavior change as the lever for helping the most people and having the biggest impact?
TVG: One thing that occurred to me as we were trying to attract clinic staff was that we were dealing with a shrinking primary care workforce that was not in the best mindset. A lot of primary care physicians were questioning whether they should have gone into primary care, or even medicine.
We had a model that was different from the usual. It was full service, whole-person health. We needed clinicians to be thinking more holistically about their patients and be equipped to work as teams more effectively than they do in most primary care practices.
I also had this crazy idea based on the concept of flow, the work of Mihaly Csikszentmihalyi. And it happened that the person leading our overall efforts was an early positive psychology-based person who saw behavior change as central to everything we were doing.
For me, I was thinking about clinicians, and what if working in one of our health centers could actually be uplifting? You know, not all about electronic health records and reimbursement and billing and policies. What if in these clinics they could focus on the heart of what clinicians want to do, which is care for patients, be thoughtful, and be in command of their ability to guide a patient toward their best health?
What if we could build a clinical experience for the physician or any other clinician that would make them energized at the end of the day, rather than worn out? And, would that have positive effects on their patients and on health outcomes?
I had known Gabriella Kellerman (BU Chief Product Officer) and knew a little about what she was working on, so I had a conversation with her about what we were trying to do. She said, “Well, I'm sure we can help. I'll talk to Martin Seligman.”
She came back and said there wasn’t a lot in the literature on whether “mentally fit” (resilient and behaviorally sound) clinicians have better patient outcomes. But, she said, we'd love to go on that journey with you. So we initiated a coaching product for our new clinicians, and it had incredible uptake. About 85% of our clinicians took a coach. That's huge for any population, but for clinicians — you know, we don't need help: we are the helpers, we're fine — it was amazing. Something like two-thirds of them had multiple sessions, over a fairly short period of time.
It was amazing, and it really started dawning on me. I alluded to this in my LinkedIn post, that for a long time I misunderstood the role of behavior change in clinical medicine. But the reality was even broader: I had missed the role of behavior change not only for patients but for clinicians.
MW: So behavior change, not just in patients but in clinicians. And by extension, behavior change for any area of our lives where we face challenges or want to perform better or live better?
TVG: Once you’ve opened your eyes to it, it becomes the central challenge of anything you're trying to do in healthcare. And then even more broadly, anywhere in life. So talking again to Gabriela and then Eddie (co-founder Eduardo Medina) and several others, it became so clear that this was an opportunity to do what I said was the common thread, which was, have an impact as broadly as possible and care as deeply as possible.
If we think about making behavior change available to everyone, we can give people the tools to become the best version of themselves, to achieve their goals — whether that’s how do I improve my health, or how do I be a better spouse or parent, or how do I become a better worker in a particular environment.
MW: What are the two or three priorities that you see standing in the way of a healthier, happier US population?
TVG: We’ve heard a lot about languishing, this condition of not having a clinical mental illness but also not being well or thriving, an absence of mental health. It’s a state that a lot of people were in even pre-pandemic, but it took the pandemic for us to stop and notice it. It’s a real concern that such a large portion of the population is living in a state of disconnection from others — dissatisfied, disengaged, and apathetic. The pandemic just made it worse for so many people who are feeling threatened, maybe more fear-based and reactive, and more hopeless.
So, paramount for me is the need to build resilience and empower people with skills to be better equipped for whatever challenges and change lie ahead. We live in a fast-paced world — we don’t know what’s coming next, but it doesn’t end at COVID.
Then, I think we've got three big forces coming together doing a lot of damage to individuals and communities. The first one is loneliness. There’s a sense of disconnection from each other, and a sense of nobody really knows who I am or cares who I am. And I'm not sure I even know because I don't have that sort of mutual definition that happens in a healthy relationship where you understand yourself relative to others.
The second is a fundamental loss of understanding and trust in institutions. Things that we grew up with and took for granted — your local school or government or church. We’ve lost that sense of trust and reliability with these institutions that were a big part of our lives. That has a huge impact on our communities and personal lives.
Then third, is this belief or feeling that there's something bigger than us out there, that there's a broader cause. That it's not just us.
I think those three things have led to a lot of alienation and the stress we see in life. Life has become materially richer and in some ways more convenient and easier, but it also feels harder. Holy cow, I just ordered my kids' school supplies on my phone with three taps. How is that harder than going out to eight different stores with a list? It seems easier, but ultimately it sort of turns us inward and severs some of those connections.
MW: So why BetterUp?
TVG: When I think about the languishing problem — the increasing prevalence of poor mental health — we have evidence from research, from our own data, and from our customers that coaching around mental fitness skills and behavior change is incredibly effective to address languishing. And with loneliness and distrust added to the mix, human connection and precision care become so important to meet people where they are and remove barriers to seeking and receiving help.
So, if we believe that behavior change is core to everything we want to do in life, and that having the skills to manage and improve our own mental fitness is critical to human flourishing, then coming to BetterUp where we can actually help people with these things just became a remarkable opportunity. Mental fitness isn’t just for executives, it's not just for any particular population, it's really for everyone. To join in this thing that had already shown its value and had audacious plans to bring mental fitness, behavior change, personal accountability, and growth to everyone — that was really exciting.
MW: What's your priority for the next few months at BetterUp? What are you excited about getting involved in?
TVG: One is really understanding the broader platform and vision for it, especially as it relates to BetterUp Care. The second, and this hearkens back to something I've worked on throughout my career, is, how do we measure the effect we're having? Especially measuring and reporting outcomes in ways that'll make people say, “Oh, I get it. I know what you're doing. And I believe in what you're doing.” Really understanding how we look at the populations we've served and how, where, and in what ways they're improving.
Tom joins BetterUppers around the globe in building the most scalable behavior change platform in the world to help people everywhere live with greater clarity, purpose, and passion.
