What is the Behavior Change Marketplace? Discover Cassie Wallace with Zeal Care

Cassie Wallace: We’re tackling what we call the 'behavior change marketplace.' It’s not just about clinical treatments—it’s those daily behaviors impacting health. We help people navigate that space, with the support and coaching they need to truly make a change. And that's where ZealCare is very unique.  I think it's unique, number one, that we're focused on behaviors. Number two, that we're focused on the specific subset of patients, that 5% of Complex Chronics. Those guys are hard to change. And we've got success in that space.

Ty Hagler: All right. Hello and welcome Cassie. Thank you so much for joining us. To get started, could you just tell us the story about how you got involved with your current company, Zeal Care?

Cassie Wallace: Ty, thank you so much for having me and giving me the chance to talk about Zeal Care. I am very passionate about this company and just love everything that we're doing. Before we get into that, got started really through relationships, networking, and my passion for working with solutions focused on advanced illness or that far end of the spectrum for patients and improving quality of life.

So at the end of the day, it's all about For me, it's all about improving quality of life for the patient. I've got a background in the health plan space, been in healthcare, venture capital, and have also worked with early-stage companies, getting them off the ground. All focused in this space, all focused on. Improving the patient's quality of life. First, I was in palliative and hospice care and now with zeal care, focusing on the chronic, the advanced complex chronic condition space and how I got here was really because of Maureen O'Connor. So, everyone, she's wonderful. The team at Zeal Care is fantastic.

And Maureen and I worked together several years ago at the health plan at the venture firm, and then we've stayed connected over the years and she was telling me about the work she was doing. Really at first getting zeal care spun out of Duke, and it was new, and it was this exciting opportunity and she asked me to come along for the ride and join her and upon the very first, so she described it to me.

And I was like, Where do I sign up? This makes total sense. And then I met the founders, Dr. Ralph Snyderman and Dr. Connor Drake, and was like, yes, I've got to partner with these folks. They are amazing and innovative. Just think they think very differently, and they like me are all about. Not only the outcomes, because, of course, we all want to we want to focus on the triple A, the experience, the improved clinical outcomes, reduction of costs.

We, we want, we all want that. We want to focus on it. But at the end of the day, it's about how do you get to the heart of it? And how do you bring relationships into the picture? And I think that's really, important. Key for me in my personal life, professional life. And then I think also when you're looking at effectively managing healthcare relationships are key.

Ty Hagler: Absolutely. And so you you weren't the founder, but you recently had a title change, right? To being president of Zeal Care.

Cassie Wallace: Thank you. I started out with zeal care as how can I help? So really coming on board, how can I help was very quickly brought into the chief operating officer role and our founding CEO Maureen is taking a step to focus more on the board and senior advisor for the company.

She's still here and I rely on her very much, but I'm really taking the reins as we're at a transitional point in the company, getting, off the ground, launching and really going from ideation and creation to operation, operationalizing the company.

Ty Hagler: That's excellent. That's a great lead in. Could you tell us more about Zeal Care the company? What does Zeal Care do?

Cassie Wallace: So zeal care is, I would say, an innovative. But back to basics, behavior change company for those with complex chronic conditions. So think about the 5 percent driving about 50 percent of the cost. of those individuals who make up that we always look at health care statistics, that statistic.

Many of the folks who make up that statistic have very complex chronic conditions with multiple hospitalizations, ER visits medications in there. the individuals are overwhelmed. Chronic conditions that make up many of the chronic conditions impactable or health can be improved through behavior change and lifestyle changes. And that's where zeal care comes into place. We actually partner with the individual, the patient, to create a more empowered participants. You'll hear me throughout refer to patient. You don't, I try not to call them patients. I call them participants because in a lot of ways, or we see patients as being we're passive.

Something's being done to us. We're going through the system, a participant. Hey, I'm in the driver's seat. I'm leading the way. I know what I want to do and I'm directing. My path and that's what we aim to do is really change that mindset the patient to become a participant in their health. And then how do we hand hold through those  behavior changes that need to happen?

For example, behavior changes like medication adherence. dietary nutrition changes, exercise. It's not just your physical health. It's your mental health. It's your relationships. It's your mindfulness. It's bringing it all together. We also address some of the barriers to care, what we know, what we all call social determinants of health and then have response to that.

So it's like, how do you take this whole person approach? someone who's very complex to someone who's very overwhelmed and give them the tools they need and the support that they need to be able to make the changes they need. Most importantly, when I say it's about relationships, it is where we start, focus on relationships from the very beginning.

So it's from the 1st outreach for enrollment into the program our 1 on 1 integrative coaching sessions. Thanks. our peer and caregiver support group sessions. So we bring people and relationships in all different ways, still getting clinical care. You're still going to see your doctor, but we come alongside and we're that support that really helps those patients become participants.

Ty Hagler: It almost sounds like a coaching model where you've got the one on one and then group, and then you've got direct primary care, right?

Cassie Wallace: It's a coaching modeled model delivered virtually. So just like you and I are having like a zoom or a teams conversation, it's delivered virtually. It doesn't matter where you are. You may have transportation barriers, you may have physical limitations, you can still get that level of support.

So encompassed, it is integrative health coaching with a lot more wrapped around. So I'd like to talk about I like to think about zeal care as it's what we all, it's what we. the capabilities that we've brought together that makes us so unique. And I think when I talk about relationships, we bring together this curated community of individuals who are like you.

We put our groups into cohorts of 8 to 12 individuals. We feel like that's the right amount for interaction. And it's people who are going through the exact same thing you're going through.

They know it. They're living it. That lived experience is huge. I was actually reading an article just last week about, the social network. a catalyst it is to improving behavior change. And so that's at the core of what we do. Wrapped in mindful meditation, ensuring that we're looking at the mental health and we're looking at the physical, mental, spiritual aspects of that person to ensure they're supported in the way they need to be supported. I would say we are the state when people always talk about health tech we are a relationship based company, enabled by technology and we've got a really great platform where it's AI [00:08:00] platform where we're able to dose the intensity of the program and personalize the engagement of our program.

So I'll talk a little bit more about that as we get into today.

Ty Hagler: So congestive heart failure that's a complex condition that affects millions of people. It's my understanding that zeal care has a major focus on treating congestive heart failure. Why focus on that particular indication?

Cassie Wallace: So I would say, heart disease is the number one chronic condition affecting adults in the U. S. and congestive heart failure is a major factor within that heart disease. About 70 billion dollars every year is spent in the U. S. on CHF alone.

Ty Hagler: I had no idea it was that much.

Cassie Wallace: of patients, billions of dollars.

Only you look at just the macro or the, economics of the condition, it's an overwhelming and high burden diagnosis for patients as well as their caregivers.

So they need solutions that go beyond education because they will get a therapeutic plan Has lots of new medications. They're going to be probably be on a special diet. They're going to need to make changes And they're going to need to manage themselves. So you're going to have to manage yourself differently Self management equates to behavior change.

What am I going to have to do differently to manage this condition that I now have? Or one that is now getting worse where I am it's, harder and harder to manage. I would say statistics also, there's a lot of room for improvement. About 60 percent of congestive heart failure patients are not adherent with their medications. And about 80 percent of congestive heart failure patients are not adherent to lifestyle changes that need to be made for their therapeutic plans to work. That's our sweet spot. That's where Zeal Care comes in.

Ty Hagler: You think about how hard those habits are that may have been lifestyle habits that led to congestive heart failure, how hard that would be to break at that point.

Cassie Wallace: Right, they're lifelong habits, or it's a way that you've always lived. And now you have to change that. Change is hard. And while you may be the most motivated person or a self starter. It's really hard to maintain those changes. And sustain them down the road that's where zeal care comes in. We've got in our evidence base. I don't even think I talked about that in our intro that we're, we are actually a spun out of Duke health. For over a decade, the model has been tested, validated, adapted to create what is now the zeal care approach and through all the testing and validation, we've seen huge savings high engagement, high satisfaction, high retention, [00:11:00] like in the 80s. So that's

Ty Hagler: Oh, wow.

Cassie Wallace: percentage. That's huge, but it's also we see clinical impacts sustained behavior change. So for example, our diabetes program, we saw a sustained 654 per p. m. savings. Up to 18 months post program.

Cassie Wallace: I spoke about Nora when she was talking about being in the driver's seat.

So kept in touch with Nora. She was a part of those early studies. And three years out from the program, she is still embracing the behavior change that she learned through the program.

Ty Hagler: That's incredible. Yeah.

Cassie Wallace: one of those things when you hear the stories, you're like, Oh my, I've got to get this out to everyone.

Everyone needs to know about this. And I think,

too I would say getting off the congestive heart failure topic a little bit, use we as a team. And I have to say, this is the best team I've ever worked with. The saying that says yourself with people better than you that bring you up,

So every day it's, how do we think differently? How do we, the problems that need to be addressed and do it in a kind and compassionate way?

Ty Hagler: Yeah. Yeah. And your team has fallen in love with solving this problem, not necessarily like a solution or technology that you're,

Cassie Wallace: It's solving the problem and how do we do it? And how do we. And we hear these individual stories and you just say, we've got to get this out to the masses, but it's also over the time that we've taken to build the company. So we spent out of Duke, we took time to build our technology, build the team build our curriculum, expand our program, look at our go to market strategy.

And here in the last year or so we've, really gotten traction with our customers. But during that time, I think every member of the team [00:13:00] has had. of an immediate family member where this program is needed. Where we see it in real life, we see, my gosh, if they had this community surrounding them, if they had this guide, to help them go through what they're having to navigate, it would change their life. And it is life changing for those who have experienced it, and we hear that over and over again.

Ty Hagler: that's one of the amazing things about working in healthcare is it's almost you're the person who is preparing, packing the parachute knowing one, one day you may need to be the person that puts that parachute on and jump out of the airplane. Healthcare affects all of us.

And the work that you're doing has ability to one day, maybe even, impact like members of your team and how rewarding would that be to see the, something that you spent so much time and carefully crafting, making an impact down the road for family members or for team members.

Cassie Wallace: Exactly. And so it's, we see the  opportunity. So we don't just see it as like we were talking about industry to statistics, huge opportunity. We see the opportunity acutely.

Ty Hagler: You've talked a little bit about healthcare systems and how they're currently addressing conditions like congestive heart failure., it seems like there's not this sustained program or maybe there's not even the capacity to do this kind of sustained whole person effort.

Yet at the same time, this is what seems like is needed in order to prevent rehospitalization rates. So let's head accurate.

Cassie Wallace: that's definitely accurate. And I think health systems are doing a really good job working with patients. When they're in the office or they have a clinical encounter. I think where there's an opportunity and what may be missing is what's in between. So for example, you're having, you have your clinical encounter, you get your therapeutic plan, now what? So you can imagine, I don't feel well, I'm overwhelmed. Not only do I have congestive heart failure, most likely I have another chronic condition coupled with it. I also

Depression or anxiety along with that. And you can imagine I'm overwhelmed. I don't know what to do. So what do folks do when they don't know what to do and they feel paralyzed? They do nothing. So what,

Then what happens in healthcare? Then they get worse. They go back to, they have another encounter. They found out they're a little bit worse, and now there's more stuff to do. There's more on their list of things, their therapeutic plan. They need someone to come in, babysit the way through.

So let me, I feel like we come in, we wrap around the individual, we give them what they need, so it's not just our coaches talking and helping them through. It's let me get you up with peers who are dealing with the same things you're going through. What's really unique in those peer sessions is we call it.

That's where the magic happens is you start to see these relationships form. You start to see them bond beyond, you that our meeting where they're forming walking groups, they're texting each other reminding them to take their medications and they feel like they've got this really unique, small sphere of people who know exactly what they're going through and they support each other differently and that's, beautiful.

So think about you've got. We call it putting the training wheels on. So it's just like riding a bike. You put your training wheels on, you're riding the bike. Someone's holding onto the seat too. Just, so you know that someone's there we're helping you through it, and then you let go of the bike.

They're riding with the training wheels and then the training wheels come off and they're helping, they're managing themselves. They've stepped into that self [00:17:00] management, fully empowered state. And

Really what we do. But just think about and also understanding what that individual wants their help for. So that's,

It's personalized. The program is personalized to the individual. So what do you want your help for? We have examples like, I, my daughter's getting married in a year. I want to be able to walk, down the aisle with her. how do we get you to that state? I want to be able to walk to the mailbox.

I'm not able to even walk to the mailbox anymore to lunch with my group of friends. I want to be able to go have lunches again. And getting

State that's where they want their help for, it's personal we can help them get there. So we create a very specific plan to help them get there and work with them every step of the way.

Ty Hagler: And having that community where everybody else doesn't have the same misunderstanding of what the chronic disease is because everybody's living it and can fully empathize with it. And then aware of those goals, right? Yep.

Cassie Wallace: And when you say everyone's living it, we also open up our program to caregivers. So caregivers are encouraged to attend not just the one on one sessions, but the group sessions as well. So they are hearing how, it may be I'm caring for my father and, oh, he's not the only one with this issue.

This is not, this isn't just him. This is a bigger issue. It's twofold with the caregivers. They understand. a little bit better, and they're able to share with other caregivers. But they also learn how to manage themselves. Caregivers, are some of the most stressed individuals. In our society right now,

Yeah, and being a part of the sessions and helping to self manage and deal with stressors, mindfulness, meditation, they're also able to participate and it supports them as well.

Ty Hagler: that sounds incredible. I know that just the burnout rates that happen for caregivers something that people have so much stress on them, to be able to have that chance to be like taking care of yourself. I think that makes such a difference.

Cassie Wallace: It Huge difference.

Ty Hagler: So there's a lot of tech in this space as well.

Why can't and it just may seem a little bit facetious, but remote patient monitoring. Why can't we just send patients a device and solve all of these whole person problems? Like what, where does that fall short?

Cassie Wallace: I think remote patient monitoring is an excellent tool for managing patients. But it, number one, it may be too tech forward for some. But I think also when you couple remote patient monitoring with a program like zeal care with intensive coaching behavior change. They are more engaged. They understand what's going on and like we say it's a multiplier effect an engaged and empowered participant that comes out of the zeal care program is more engaged and More empowered with the other programs that may be available to them with the devices Even with their clinical encounters and the way they're able to have those conversations with their providers

Ty Hagler: It sounds like it gets back to adherence of until you're addressing some of the core behavioral challenges, you're not going to have adherence to some of these other, you say tech forward solutions that are out there that may have profound benefits, but you still need to address the whole person, which is where you're at that hub of really helping to treat patients where they are.

Cassie Wallace: right. I think even Dr. Snyderman was talking just published an article where he was looking at results from the zeal care program. And so we talk about adherence, but this goes back to medication adherence, the subset of patients. We're had about a 48 percent adherence rate to their medications for CHF.

That's not good with a program like zeal care or deploying the zeal care program with those patients. It increased their medication adherence to 89 percent and congestive heart failure, whenever, within just a matter of days or weeks becoming adherent to medications as well as the specific diet, participant begins to feel better.

Okay. They start to realize they can do this. They start, they have these achievements in small wins and you start to see like we say, the multiplier effect where it's, let's add one more thing. Let's add one more thing. Let's take another step in the right direction.

Ty Hagler: Yeah. It sounds like that. Incremental phased approach really helps somebody to have a series of small wins that moves in their direction. So going for zeal care and maybe the first win that you've had, where you're seeing really real movement is congestive heart failure. What are some of the next indications that zeal care is considering that health systems could look to zeal care for treatment?

Cassie Wallace: Yeah our model, can create impact for health systems or really anyone who's taking on risk for costs and outcomes who have patient populations that have high costs and poor outcomes. any condition that can be impacted by behavior change can benefit from zeal care. And we actually also have programs where we focus on chronic kidney disease, dialysis care, poorly managed type 2 diabetes, as well as our newest program is in obesity management.

with co occurring conditions, and we're, continuing to develop our suite of programs. any condition, they can be impacted by behavior change. Think autoimmune is one that comes to mind very easily.

Ty Hagler: Yeah, there's some pretty specific focuses you can take, but then there's also broad applications because so much of health really seems like there's a behavioral component to it that seems like your team has really unlocked some really key strategies in order to make a sustained impact.

Cassie Wallace: a conversation yesterday, and it was dubbed the behavior marketplace. so it's, not behavioral health that falls into the mental health. It's what are those behaviors that are impacting your health that Need to change in order for you to improve and to get better, lower costs better clinical outcomes. And that's, where Zeal Care is very unique. I think it's unique, number one, that we're focused on the behaviors. Number two, that we're focused on the specific subset of patients, that 5%. So we're looking at complex chronics. Those guys are hard to change. And we've got success in that space.

Ty Hagler: As a designer, behavior change is something we're constantly thinking about, not just the performance function and benefits of whatever system we're developing, but rather what are the non product attributes? How do we have somebody feel a certain emotion from the thing that we've created?

So that we're trying to make a lasting impact on the people who interact with the product. And I think that's so fascinating with what you're working on and recognizing that sometimes it's not just a thing or a specific solution or specific moment, but rather that sustained efforts really Understand, build empathy and come alongside of people where they are.

So it's more acting in community. And then there's artifacts that can support that. But that's what I find so fascinating about what you're building with zeal care. Cause it seems like it's humanizing healthcare where there's so much that's been, I don't know, centralized and pre programmed that has, you're putting it back into healthcare the, human side of things.

Cassie Wallace: We used to call ourselves human centric. So I used to use that term a lot. Now it's more relationship because it goes beyond having a humanizing and putting having a trusted relationship and it's someone who's there with you every week on a consistent basis, how you need them, when you need them for an entire year. That is where you get real change.

Ty Hagler: And that makes perfect sense with the different coaching programs and whatnot that I've been a part of personally. That's what I'd want to see, or if a family member were to come in and start smacking me upside the head, cause I'm doing something I shouldn't be doing. And this is what you need in order to get back on course and get your health.

Cassie Wallace: I think that's, that is what's unique about Zeal Care, I think, is how we've brought together the different components of coaching or for the program. I, there, there are a lot of folks out there who are looking at condition management a lot of different companies, [00:26:00] but we focus number one on behavior change, and number two is how we do it.

So it's bringing in that peer support, it's bringing in the caregiver support, and it's having that very dosed. Dose intensity, you may need more the next person, and we're able to give that to you. You need more personalized engagement. When I go back to talking about, your health plan, what do you want your health for?

It's very personal, It's very meaningful to you. And that's how we play. We've got that human, we've got that person there who's developing that relationship to help the individuals along the way. And I think that's what's beautiful. That's what I get excited about with the company and what's been created. And I think when you hear. The stories from people who have gone through the program. It's amazing. And it's the fuel that we need to keep going because startup world's not easy. We all know that. But that's it's why it's our why it's why we're here.

Ty Hagler: Yeah. Yeah. That's so inspiring. Okay. So did you read the book Outlive by Peter Attia?

Cassie Wallace: I have not read that.

Ty Hagler: Okay. Okay. So it's, an awesome book. I definitely recommend it. He, gives this example at the beginning of the book and it's all about like, how do you increase your health span? And so much of what you're doing with zeal care, I think resonates, but he talks about Healthcare 2.0. which is around basically treating acute symptoms. So when somebody presents acutely into the health system, they're very good at providing the top surgeon, the top intervention in order to solve the 2. 0 problem. And I think what Zeal Care is doing is addressing the Healthcare 3. 0 problem, which is an accumulation of chronic health problems, accumulation of health, like wellness decisions that have been made that can [00:28:00] lead towards significant problems that are some of the leading causes of early mortality. And I think That what you're pulling together starts to address that in a neat, very compelling way.

And he's also got some really cool topics about the talks about the centurion decathlon of what are the 10 activities you want to do when you're a hundred years old and then mapping out your rate of decline before then and setting goals. If you want to carry groceries up and down the stairs at a hundred years old, you need to be lifting this much weight and going up the stairs at your current age.

And it's just, there's so much about what he's written that maps to what you're doing. And for anybody who's interested in longevity and healthspan and. I think that's a, what you're building goes right alongside where I think the future of healthcare is going.

Cassie Wallace: I agree. So when we, I have been in more and more conversations lately about lifestyle medicine, longevity, [00:29:00] medicine, and focusing on longevity, and that's exactly where we are is what decisions are you making today? And being able to reverse? where you may be and making by changing your behaviors, making different decisions and then sticking to it.

Outlive is going to be on my reading list. I was, I just wrapped up a book. And so now I need a new one. So that's going to be, I'll take a look at that one.

Ty Hagler: There we go. Yeah. For anybody who knows me, I'm constantly referencing books as we talk. It's a shorthand for incepting ideas cause I think there's just so many good books out there. There's none that, it's fun to share in like the books that have inspired and some,

Ty Hagler: Out of curiosity, what book did you just wrap up?

Cassie Wallace: just wrapped up The Murmur of Bees by Sophia Segovia acouple years ago, I decided for my evening reading, so I read business books industry Throughout. I usually keep one of those in my car The Rite of a Lifetime. I just finished that one. That is when I sit in carpool or when I'm in the car. But The Murmur of Bees is it's about a boy who was orphaned, and he has this swarm of bees protecting him throughout born, and he's got like a sixth sense, he's able to speak to the bees and understand, and they actually tell him to bring, Orange orchards, orange tree orchards to a certain part of Mexico to replace the crops that were not performing so well. And Some of the other, reform that was going on at the time, and so it's how did they bring. orange trees, the citrus crop to a certain part of Mexico.

Ty Hagler: Oh, cool. Huh.

Cassie Wallace: it's set in the early 1900s. So it's fiction, but still very, it was a very good book.

Ty Hagler: Oh, cool. I'll check that out. Thank you for sharing that. Okay. So as we wrap up, how can people get started with zeal care? And then maybe what's your message to people who are struggling to manage their chronic disease?

Cassie Wallace: So I would say my message to anyone struggling with chronic disease is in it by yourself. You don't have to go it alone. There is support. Living the life you want is possible and There's so much support out there for you. To get started with zeal care our customers are typically health systems and providers or anyone taking on risk, like I say, for costs and outcomes.

So I would say, contact me directly if you're a provider at a health system, or you're, you want to know more about zeal care and what we're doing, how we could work with your patient population. Please reach out to me directly either you can, you'll have my information for LinkedIn. I would love to have a conversation. And if you're a patient who wants to know more, who would love to have a program like Zeal Care, talk to your provider and put them in touch with me.

Ty Hagler: Very good. And we'll make sure we post, links to the zeal care website. And of course Cassie, your LinkedIn profile in the show notes so that people can get in touch with you.

Cassie Wallace: Thank you so much. This has been a great conversation. I feel like I could talk about zeal care, what we're doing, the need for what we're doing, the impact that we've had. I could do it for two hours. I could do it all day long. And I just thank you for the opportunity to be able to share it with the listeners out there.

Ty Hagler: It's such a compelling story and your, passion for this clearly shines through as you talk about this. And we'll have to have you on again, because as, zeal care continues to evolve and you have more stories come forward of like people's lives who are impacted.

Cassie Wallace: Thank you so much.

Ty Hagler: Thank you, Cassie. And thanks for taking the time to join us.