Summary of Zach Reitano - Building Ro and Why Healthcare Should Be 50% of GDP - [Invest Like the Best, EP.500]

Overview of Invest Like the Best, EP. 500: Zach Reitano on Building Ro

Ro co-founder and CEO Zach Reitano discusses why he believes healthcare could become a much larger share of the economy, how patient choice and direct payment can improve care, and how Ro rebuilt its business after a period of unfocused growth. He also explores GLP-1 medicines, AI-enabled healthcare, company culture, and the personal experiences that shaped his mission.

Healthcare Spending and Patient Choice

Reitano argues that healthcare spending as a share of GDP is not inherently a problem: the key question is whether people get meaningful health benefits for the money. In a more abundant future, he says, additional healthy years may be among the goods people value most. He sees the U.S. system as costly but strong at acute care, while chronic disease and high administrative costs drive major challenges.

He identifies a basic incentive problem: patients pay for care through out-of-pocket costs, taxes, and lower wages, yet often are not the customer that providers and other businesses serve. In his view, care works better when patients control the spending and can compare options, as in cash-pay services such as LASIK and cosmetic surgery.

Reitano points to direct-to-consumer access to GLP-1 medicines as an example. When patients can see prices and buy directly, he says, middlemen can be bypassed, prices can fall, and manufacturers can still benefit from greater sales volume. He argues that better price transparency and patient choice could build trust and shift the healthcare system toward patients’ priorities.

Ro’s Business and Its Approach to GLP-1 Care

Ro provides care across cardiometabolic health, sexual health, dermatology, and fertility, with GLP-1 treatment now its fastest-growing area. Reitano describes the company as a vertically integrated care platform, built with its own technology, provider network, labs, and pharmacy operations so it can expand across conditions.

He attributes Ro’s position in GLP-1 care to a combination of affordability, insurance support, access to both major drugmakers’ treatments, delivery and in-person pickup options, and multi-month plans. More broadly, he says differentiation comes from continuing to improve rather than relying on a single lasting feature.

Reitano expects GLP-1 medicines to reach a much larger share of the population as uses expand beyond weight loss and diabetes, tolerability improves, and prices fall. He sees their effects on individual health, healthcare purchasing, and society as interconnected: medicines that address chronic disease could change how people access care and affect long-term health outcomes.

Ro’s Reset and the Lessons of Growth

After raising $500 million at a $5 billion valuation in early 2021, Ro tried to pursue too many opportunities at once. Reitano says the company grew only 9% that year while carrying high costs and an $800 million preferred stock obligation. He recognized the need for a reset and wrote a memo to his co-founders outlining a sharper strategy and clearer culture.

In 2022, Ro parted ways with several executives and about 20% of its staff, then refounded the company around a single Ro brand, clearer expectations, and a more focused plan. Reitano says the business later grew roughly tenfold while operating with about 30% fewer employees than before the reset. He stresses that layoffs were painful and that avoiding overhiring in the first place would have been better.

He credits the turnaround to:

• Clearer culture: Ro defined the traits it wanted to attract and repel, combining high performance with genuine care for people.
• Focus: Teams worked sequentially on priorities rather than making small advances across too many projects at once.
• Fast alignment: Daily leadership meetings helped teams resolve decisions and maintain momentum.
• Short-term planning: Ro kept its long-term mission steady while emphasizing near-term precision, arguing that long-range roadmaps can become obsolete in rapidly changing markets.
• Strong talent: The company invested heavily in recruiting, compensation, equity, and support for top performers.

AI, Prevention, and the Future of Care

Reitano sees three forces pushing healthcare toward a more patient-centered model: more health data becoming available, AI making some expert knowledge easier to access, and new treatments with the potential to improve quality and length of life. Combining genetic, lab, wearable, and patient-reported data could help identify health risks earlier and personalize treatment.

He argues that technology and human care should be judged by outcomes. New tools should demonstrate that they work, but existing practices should not be protected simply because they are familiar. He compares this with autonomous vehicles, arguing that proven safety improvements should be weighed against the lives lost under the status quo.

Reitano also challenges the idea that healthcare must always remain human-delivered. He believes software and AI can make forms of high-quality care more widely available, while maintaining a focus on patient safety and results.

Reitano’s Personal Motivation

Reitano connects Ro’s mission to his father, a doctor who helped him through a heart procedure as a teenager and advocated for his care when he needed growth hormone. Those experiences, he says, showed him how healthcare can alter a person’s life trajectory. He hopes to extend that kind of support to more people through software and operations.

He also describes his own preventive health regimen, developed with medical guidance in response to his family history and cholesterol levels. His example illustrates how he thinks about treatment decisions: start with a person’s goals, risks, and preferences, then weigh potential benefits against costs and side effects with a provider.

The episode closes with a story from when Reitano was 15. As his father was leaving a visit, he asked Reitano to say “I love you.” Reitano later learned that his father was having another heart attack and wanted their last words to be loving. The experience taught Reitano to express love openly and remains one of his most meaningful memories.