Thoughts from the team

2013 Year in Review

Wednesday, January 1, 2014



Welcoming Julia Winn (BetterFit) to the team

Monday, December 9, 2013


winn demo cropped
Read more about Julia’s journey in an exclusive interview with Health 2.0

We’re delighted to welcome Julia Winn, founder and former CEO of BetterFit Technologies, Harvard spin-off and an alum of the Techstars Boston program (2012), to the family.

Julia built the first prototype of BetterFit during her senior year at Harvard College. A year later, BetterFit graduated from the Techstars Boston program, raised seed funding, and deployed with its first paying customer.

BetterFit focused on individual patient care built around natural language processing. BetterFit’s initial product was a tool to predict how a person would react to a new drug based on her reactions to previous drugs. Over time, Julia and her team realized the complexities in doctor-patient communication, and pivoted their platform to enable automated, personalized text message conversations with patients between doctor visits.

Enhancing the provider-patient relationship using machine learning is core to the mission, just as it was for BetterFit. In a changing healthcare landscape, we believe in finding talented leaders like Julia who can help us find creative answers to both technical and business challenges. In addition, we have other team members that bring outstanding experience to, including our product manager Sasank Munduri (Google), Jimmy Do (Pipette), an expert in mobile computing, and senior engineer Jeremy Johnson (Healthonomy). As a company, we pride ourselves in our entrepreneurial spirit and can-do attitude, which is essential for driving change in a complex industry.

Julia is already hard at work helping us think through some of the biggest strategic questions facing, a valuable asset as we focus on deploying our platform with innovative healthcare partners. If you’re interested in learning more about our strategy and/or working with us, please reach out to us at or on twitter at @ginger_io.

Time for the second annual Teamsgiving!

Thursday, November 28, 2013


Anmol bbq
Last year, we kicked off the holiday season with Teamsgiving, a chance for all of us to reflect on what we are thankful for as part of the team. This year, we’re putting a slight twist on it and making it a tweetable #teamsgiving! You may have seen some of our thoughts over the past week on twitter — here are a selection of the rest!

A couple of themes have emerged – we’re thankful for the chance to work on something with impact, to work with committed clinicians and patients, and to work with each other. And don’t forget the ping pong table!

Let us know what you think — if you’ve worked with the team, what are you thankful for?

Ilan Elson Schwab (@elsonschwab): I am thankful for good health and the great partners we have that are excited to promote more good health.

Peter Smith (@petersmithus): I’m thankful for working with clinicians and colleagues who embrace the mission of proactive care and improved patient outcomes.

Naomi Kincler (@namikinc): users who are trailblazers, working tirelessly to improve their own health & help better the health of others by simply sharing their experience

Karim Wahba (@karimwahba): Thankful to be working with a wicked awesome team @ginger_io on a truly worthy cause

Jeremy Johnson (@jeremyajohnson): I am thankful to be impacting the way healthcare is delivered in a scalable fashion with a talented team that truly cares.

Julia Bernstein (@jfbernstein): I’m thankful to work on an inspiring mission and work w/ people who can help make it a reality, both in and outside @ginger_io

Kate Farrahi (@kfarrahi): Thankful to have met so many interesting and talented people at Ginger and to be part of the exciting data science team.

Mahesh Sharma (@maheshsharma): Thankful for all the amazing people I get to work with, just like a family away from home :)

Julia Winn (@julia_winn): I am thankful to work with so many incredibly talented people who are all trying to make a difference in healthcare.

Michelle Patruno: I’m thankful for our wonderfully supportive team. Our teams love of food and terrible movies. And all of the new additions!

Sai Moturu: I’m thankful for a thoughtful team, a growing data science group and the new ping pong table :)

Integrating mental health into primary care: an idea ready for the mainstream

Friday, November 8, 2013


CIHS infographic
Image courtesy of

At, we hope for a future where mental health is central to managing a community’s health. As we discussed in our last post, addressing mental health is particularly crucial for helping patients manage other chronic diseases like diabetes, lung disease and cancer. Our dream is for our technology to be a part of the revolution integrating behavioral health as an essential component of any well-functioning primary care system.

If you follow our blog posts, you probably already know how much we care about mental health. It’s still sobering to think of how broadly mental health problems affect our country: a 2008 report estimated that 26% of Americans suffer from a mental health disorder, and that 6% have a severe disorder. This adds up to nearly 60 million people in America with a mental health disorder. That’s staggering.

These statistics aren’t just faceless numbers, either. I encounter the reality of the burden of mental illness in my clinical work every day. It’s the young man with untreated multiple sclerosis with progressive pain and weakness because of an undiagnosed mental illness manifesting as uncontrollable irritability and anger that no physician had tried to treat before. Or the middle-aged Dominican woman with depression and knee arthritis who didn’t treat either problem and bounced from primary care practice to primary care practice because no one could find her a Spanish-speaking therapist. A common story I hear from patients is that it was just too hard to find a mental health professional, so they stopped looking.

The most credible proposal to fix the problem of mental health access is fundamentally changing how mental health care is delivered. Instead of piecemeal access for whoever is lucky enough to have a psychiatrist, psychologist or social worker nearby, health systems across the country are transforming their primary care infrastructure to integrate mental health care directly into primary care. This makes sense for a number of reasons:

1) In the US, Primary care providers are the frontline for medical care. They are better suited than anyone to address mental health in their communities. It has been estimated that up to 70% of primary care visits stem from psychosocial issues. In addition, diagnosing and treating mild or even moderate mental illness is not too complex for primary care physicians. However, it makes practicing much easier to have the support of a behavioral health infrastructure to back up your decisions and help with complicated cases.

2) Payment reform and the Accountable Care Organization movement means that treating mental health doesn’t mean losing money. In most markets today, mental health care reimburses poorly, leading to closure of psychiatric facilities and prompting health systems to avoid developing a strong mental health infrastructure. However, payment models are increasingly switching from purely “fee-for-service”, where physicians get paid for every service they provide, to a “bundled payment” model, where physicians get paid a fixed sum to take care of a large population of patients. At a high level, the overall incentive in the bundled payment model is for physicians to save money by improving their populations’ health to reduce avoidable health care use. And it turns out that treating mental illness is a very effective way to avoid excessive health care utilization.

3) There is also accumulating evidence that primary care and behavioral health can do amazing things when they work in the same place. The most widespread model is the IMPACT program, which involves integrating a psychiatrist and population care manager into primary care to manage depression.  This team, together with the primary care physician, can provide much more comprehensive management and follow-up for patients with depression. The model has spread to over 500 clinics across the country.

4) There’s also legislation to help increase mental health access for all: in Massachusetts, a bill is being proposed the would compensate psychiatrists for electronic visits at the same rate as an in-person visit, which could be transformative. There are also pilots of electronic psychiatry visits, or “telepsychiatry” being piloted in over 40 states.

I’ve seen all of these factors in play firsthand. My clinic happens to be one of those great places where primary care and behavioral health can work together. On my clinical team, there’s a social worker who meets with our population manager and a psychiatrist weekly to coordinate care for all of our patients with mental health needs. If I meet a new patient who has a mental health need (and many do), I have them fill out a comprehensive form and then our social worker helps to find the right place for their mental health care. Together with the social worker on my team, we have helped almost all of my patients with serious mental health needs into the loop of the best mental health professional they needed. And once that loop is established, we are in continuous contact about how to thread together our patients’ mental and medical health care. By integrating behavioral health into primary care, we are able to treat the whole patient, not just the symptoms.

How do you integrate mental health into primary care? Join the discussion on twitter by letting us know at @ginger_io!

Why Mood Matters

Monday, September 30, 2013


Note: This was cross-posted by our partners at UCSF’s Health eHeart study. Sign up today to contribute to the fight against heart disease!

health eheart question

A New York Times article by Columbia’s Dr. Eric Kandel makes a convincing argument for the “New Science of Mind,” which posits that our minds are directly connected with the biology of the brain.  Along with, we believe that our minds are also connected with the biology of the body. Understanding our mental health, not only our physical vital signs, is critical.

This may not seem intuitive at first — it’s easy to understand how an objective physical measure like blood pressure or heart rate impacts a condition like heart disease.  It can be harder to make the connection between a “soft” question about something like mood and a chronic condition. However, a new body of research is convincingly making the case that mental and physical health are closely linked.  Understanding mood change could very well help us understand why some people develop a chronic condition, or respond better to treatment.

In particular, a number of studies looking at the impact of depression and anxiety that are co-morbid (or present with) chronic conditions have found a real connection to quality and cost of care.  In general, people living with chronic conditions have rates of co-morbid depression ranging from 25-50%.1 This translates to a real personal and economic impact — undiagnosed patients are less likely to be adherent to treatment protocols, which can lead to costly complications.

For example, research has shown elevated levels of depression after diagnosis in cancer patients (and their spouses).  Similarly, people living with diabetes are at high risk for depression (as well as stress and anxiety).  For heart disease, it’s a similar relationship, with both a higher prevalence of depression (40 to 60%) among heart disease patients, as well as a possible biological rationale for that number in how our bodies react to stress.2

And the relationship goes both ways. In addition to chronic conditions leading to elevated levels of depression, depression can also impact whether someone may develop a chronic condition.  According to a recent study, “depressed older adults (defined as those over age 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than similarly aged people who weren’t depressed.”3 These statistics hold for conditions like heart disease, where “30 to 50 percent of patients who suffer clinical depression are at risk of developing cardiovascular disease.”4

Given this clear relationship between mental and physical health, how do we measure something that seems so subjective?  Self-report questions can be a good starting point.’s research, done at MIT Media Lab shows that you can use self-report answers to train a model to find patterns in sensor data — like the movement and communication data from your phone — that suggests when someone might be feeling down.

So that’s why we ask mood and related questions — to help us better understand the relationship between mental and physical health.  With your help, we can make providing the best care for both mental and physical well-being part of how we treat chronic, and often go untreated.  In addition to the psychic cost of conditions.

Want to get involved? You can sign up for UCSF’s Health eHeart study and contribute to our understanding of CHF today. Or join the conversation on twitter at @ginger_io and @Health_eHeart.

Looking for more information? If you or a loved one is currently struggling with co-morbid depression, this booklet from the Behavioral Diabetes Institute is a good source of information.


What we learned on our summer co-op

Friday, September 6, 2013


This past summer, Jennifer Blight and Jonathan Acevedo, students at the University of Waterloo, joined us as engineering interns.  While they were here, we all learned a lot about Canada.  We asked them to reflect in turn on what they learned from us. interns

The grumblings of Samuel Clemens aside, San Franciscan summers still have nothing on Canadian winters. It’s been an amazing four months for the Waterloo interns here.  We both feel that we’ve learned a lot in a very short time. Hopefully we have become better developers for it; but often the biggest challenges are not about writing code. These are a few of the ‘life lessons’ that will accompany us as we return to the frozen North.

Ask Stupid Questions

Everyone here has their own area of expertise, no one knows everything, and the whole team is open to questions from anyone about anything. You’re not just encouraged to ask questions, you’re expected to; because you learn faster, and produce better results more efficiently if you get the right information quickly, rather than fumbling around by yourself. So ask questions. Ask about your work, ask about other people’s work, ask questions even when you think no one has time for them.

(and ask “Why?”)

Understand the logic that goes into each decision. Be critical. Why am building this? Why do we do it this way instead of that way? The answers to those questions aren’t just for your information; the act of explaining makes the answerer accountable for their reasoning.

Your Opinion Matters

Your opinion matters more than you think. One of the first things that we were told is: “Everyone on this team will treat you as a full time employee.” This has been true throughout our entire internship. Overhear someone talking about the product you built? Feel free to step in. Brainstorming new product ideas? Jump in. Racing to the finish line for the team scavenger hunt? Sprint ahead.

The entire team is constantly striving to learn, innovate, and to better themselves. Everyone is trusted to be in charge of their schedules, and the work that they do.

Own Your Work

Perhaps one of the hardest things about being an intern is unlearning the instincts of a student. There are no predefined requirements, no rubrics and, often, no right answers. You’ll be given a lot of autonomy and expected to make your own decisions about scope and direction. We have many mentors, but often there’s no direct supervisor. You have to be self-directed, explore, figure things out, and occasionally take leaps. The result is a project that is completely and uniquely your own; something you have nurtured from its inception and something that you will be reluctant to leave.

Want to join the conversation? Let us know what you think at @ginger_io. And check out our team (and our openings) 

Learning from our partners and from each other

Wednesday, September 4, 2013


At, we believe that our product is only as strong as our people.  From the team members who work tirelessly to build something that fills a need to the clinicians who use our dashboard to the individuals on our app, our technology is about enabling people to provide and receive better care.

As we’ve grown, it’s been really important to listen to all of our people to find out what motivates them and how we can make them successful.  Cincinnati Children’s Hospital and the C3N Network, with whom we’ve been working for over a year, have been essential partners in this process.  We recently launched a big project with them to study Inflammatory Bowel Disease in adolescents. As part of that launch, we featured those who were contributing to science by using the app.  Today, we also wanted to highlight some of the other people who have helped make (and our work in IBD) what it is today.

Dr. Shehzad SaaedThe Doctor

Dr.  Shehzad Saeed of the Cincinnati Children’s Hospital has been treating patients with IBD for the past 15 years.

His challenges: Over those years, he’s seen his patients struggle with self-management skills and the transition to adult care. He himself has faced challenges around access to real time patient data that would allow him to provide effective care to engaged patients.

Why Given these concerns, he’s excited about how can provide a snapshot of how each patient is doing so that visits can be much more effective.

What we’ve learned from Dr. Saeed: He’s given us great feedback around how to drive more effective pre-visit planning and empower patients.

Cathy Reeder-McIntosh, MPH, BSN, RN, CDE

The Educator

We’ve been working with Cathy Reeder-McIntosh, MPH, BSN, RN, CDE, through our partnership with Novant Health for over six months.

Her Challenges: While her work focuses primarily on at-risk people living with diabetes, she faces similar issues to the C3N team. One of the biggest challenges she faces is figuring out which patients need to be reached out to each day.

Why As a nurse, has the potential to increase her impact by letting her talk to the right patients each day. Additionally, in her personal life, she uses to help her manage her own diabetes. She likes that it gives her a chance to stop and think about how she’s doing every day.

What we’ve learned from Cathy: Cathy has been a very important partner in helping us think through how to design tools that are easy to use and empower the clinician.  We’ve even named our latest dashboard prototype after her!

Jimmy Do

The Engineer

Jimmy Do, co-founder of the mobile health startup Pipette, joined about a year ago. He works primarily on our mobile apps.

His Challenges: Jimmy is constantly thinking about how to build products that provide greater context and intelligence to doctors and nurses to enable them to better help patients. He relies on the data gathered from participants in our studies to make the tools he builds more accurate and useful. He also uses that data to decide what not to build, which is always a challenge for a company with a lot of ideas.

Why Jimmy joined because he was excited about the idea of working on a product that could dramatically improve health care. His ultimate vision is of a company that replaces the paperwork and manual processes of helping patients recover and stay healthy.

What we’ve learned from Jimmy: Jimmy thinks empathy needs to be a part of everything we do. He keeps us honest about putting people first as we work together to build

Are you excited by what Dr. Saaed, Cathy and Jimmy are doing?  We need your help and we want to learn from you!

If you or someone you know is living with IBD and is age 13-25, learn more and sign up (or share) today!


True reflections on a summer at

Sunday, September 1, 2013


Chad Kamisugi joined us from Stanford as a patient engagement intern.  You can read more about his adventures at and as a member of True Venture’s TEC program here, and see what he learned below.

With every end comes a new beginning. I could not have imagined the amount of learning, new experiences, and relationships I would have made this summer at From the moment I walked into the office for my interview to the moment I said my goodbyes, it has been the people that have made this experience so meaningful.

I have been reminded of how important it is to surround yourself with quality people. By the end of the summer, every member of the team felt like family and brought such a unique perspective to the table. Each personality and idiosyncrasy added to the vitality of the work environment and pushed me to think and grow in unexplored ways. Whether it was a conversation about the technical challenges of building a new dashboard, the mathematical principles behind the building of an igloo, or how to make the most of college, every moment together was full of learning.

Perhaps what I appreciated most about was the thoughtfulness. Decisions were approached very rationally. We spent a lot of time making sure that there was solid reasoning behind each course of action. This dedication to rigorously examining ideas permeated through the culture of the organization. In particular, feedback was an essential component of the fabric and I was constantly pushed to think about what was going well, and what could be improved. I appreciated the sincerity with which feedback was sought, and the safety I felt to share my opinions.

In my role working on patient engagement and account management, I had the opportunity to interact with different partners and users to better understand their needs and how we can best meet them. It was moving to hear the stories of some of our users and the hope has given them. It was during these conversations that I began to understand both the enormity of the problems we are trying to tackle, but also the great potential we have to improve the quality of life for so many people. It was moving to reflect upon the potential impact of our work and energizing to think about the talent and ambition of those on the team to solve these problems.

I feel so grateful to have had the privilege of working to solve such an important problem alongside such diverse, thoughtful, talented, and empathetic people. I return to school for my junior year with a much broadened perspective and understanding of not only the healthcare space but also life in a startup. Though my official summer internship at has ended, the meaningful relationships that were forged during my time there have just begun.


Understanding the AMA’s newest “disease”

Tuesday, August 13, 2013


Last month, the American Medical Association voted for the first time to call obesity a disease, classifying over 78 million adults and 12 million children as “sick.” This comes after a rash of articles attempting to better understand contributing factors and proposing individual and societal solutions.

With multiple partnerships in diabetes, we’ve become very interested in understanding how diabetes, and the related condition of obesity, can impact overall health.  However, with all the new information out there,  this can be a daunting task. For our own benefit — and hopefully yours — we’ve taken a pass at sorting through the research and understanding what it means for us as individuals.


Genes and skinny jeans

In July, researchers at Boston Children’s Hospital announced they had found a gene in rats that, when deleted, made those rats extremely obese.  Interestingly, the gene seemed to affect the relationship between calories consumed and weight gain; rats without the gene could eat 15% less than their control peers and gain the same amount of weight.  While these types of gene mutations and deletions are thought to be relatively rare, this research helps us better understand the link between genetics and obesity.

What it means for us: Unfortunately, not much today, as much as we’d like to blame our genes.  Longer-term, research like this could help us better understand the mechanics of obesity and potentially devise treatments that can help us protect against weight gain.

Fighting fat with fat

In February, a New York Times Magazine headline promised an introduction to “The Extraordinary Science of Addictive Junk Food,” and how the fast food industry has conspired to make bad for us foods irresistible.  Just a few months later, The Atlantic countered with “How Junk Food Can End Obesity,” discussing how “demonizing processed food may be dooming many to obesity and disease.” It’s enough to give the consumer whiplash.

Both articles agree that “junk food,” available at the drive-thru or in the check-out line, is bad for our health.  Where they differ is on whether the current junk food producers, the McDonald’s and Nestles of the world, actually have the potential to become sources of nutritious, low-calorie processed-food for people who may not otherwise have access to healthy options.

What it means for us: The conversation about the responsibilities of corporations in fighting obesity is on-going.  In the short-term, everything in moderation, and keep an eye out for healthier options on fast food menus and shelves.


You may have heard of the microbiome, or the constellation of bacteria in the human body that work in a way that allows us to function. Now, scientists are actively trying to “map” these organisms to understand what they are and how they work together.  While we have a way to go, research shows that the function of these tiny bugs in our intestinal tract – our gut biome –  may impact how we gain and lose weight.

One study looked at the relationship between antibiotics and obesity, finding that mice who received antibiotics early in life had higher total fat masses. Another area of research looks at how the gut biome changes after we change the body. A study looking at bariatric surgery patients found clear changes in their bacterial makeup.

What it means for us: This is still early research, but it is possible that someday soon our medical teams will tell us to “take 10,000 bugs and call us in the morning.”

What do you think of this new research? Let us know @ginger_io or leave us a comment!

Three things I learned working at

Tuesday, July 30, 2013


MIT senior Sneha Kannan joined as our Patient Engagement Intern during the spring of 2013.  As she wraps up her time with us and prepares to head off to med school at Penn in the fall (go Sneha!), we asked her to reflect on what she learned.


I’m continually amazed at how fast time flies. I wanted to close with a few thoughts about what I learned as an intern working for my first start-up.

Everyone has to wear many hats — and you choose what hats to try on.

I’m entering medical school in the fall, so I’m gearing up to go into a career with hierarchy and a defined role for every person in that hierarchy. I didn’t expect to be so flat and collaborative. As an intern, I could listen in on any calls I thought I could learn something from and ask about any project I wished. If I had any ideas to contribute, I could hop in.

I was particularly impressed watching the rest of team switch from idea to idea, project to project, client to client. The sheer size of the skill set everyone developed by working on a little bit of everything was amazing to me (and something I got to pick up too). The nice thing about healthcare is that the business end and tech end are tightly intertwined.  I got to observe and learn from so much more than just the couple projects I was brought in to work on.

It helps to be okay with just diving in with few instructions.

At, there were no instructions, no problem sets, no syllabi, and certainly no rubrics to tell you what an ‘A’ outcome looked like. The instruction was to present a report or document, and the rubric was “does this help” The in-between was often a mystery. I thought I’d have a hard time adapting to that, but I found I loved it. I learned so much more by muddling around and having conversations to figure out the best way to help the team. I may have been doing more work because I wasn’t sure which way the project was going to go, but it meant more learning.

I think the enduring lessons from the past few months have come from what I wasn’t supposed to do just as much what I was. Experimentation was stressful and a lot of pressure. But figuring out that right combination to help our patients was worth it in the end. It’s been so gratifying and humbling for me to see the team build on the work I’ve done.

The ideas are great, but the people make the job worth it.

I love healthcare, but ideas can only take you so far. Great companies are made by the people. I’ve heard it said before, and I didn’t fully believe it until I was a part of While is built on some solid medicine and technology, the passion, the energy, and the innovation of each individual with whom I’ve worked has amazed and inspired me to go make the world better.

What makes the team special? It’s the way the entire group was on my team and working with me on whatever I was doing. Within a few hours of officially signing on, my mentor Julia didn’t rest until I had met every member of the team virtually or in person. I was encouraged to send any important finding to the entire company, whether or not everyone knew what I was working on. I would send out reports and I’d hear feedback from people who were only tangentially involved. You’d think it would be hard to mesh with 15 people, but at it felt simple. That’s no easy feat, and that’s certainly what I’ll miss the most about my internship.

For me, my time at showed me that elusive you-don’t-know-what-it-feels-like-until-you’ve-worked-in-it start-up culture. But I think the team takes it a step further. Healthcare is a highly regulated industry with a lot of rules and set practices. While follows every single one, they’ve opened my eyes to how healthcare can be different even within that framework. How patients can hack their own health. How they can take control of their wellness into their own hands. How technology fits into healthcare. And how to identify unique places where I can make a difference throughout my career.

Questions? Thoughts? Want to hear how Sneha’s career progresses? Follow her on twitter at @SnehaTKannan.