The CEO of Spora Health on fighting bias as a startup founder and his inspirations to improve healthcare for people of color

• Dan Miller founded Spora Health in 2019 to deliver better healthcare to people of color.
• In the latest Equity Talk, Miller shares his experience with racial bias when raising funds.

Dan Miller founded the startup Spora Health in 2019 to provide better medical care to people of color. The San Francisco company, which has raised $6.5 million, aims to eliminate healthcare disparities by delivering virtual care that's informed by patients' cultures and experiences.

Miller got the idea for Spora while at a Black Buddhist retreat in the San Francisco Bay Area. The retreat was the first time he'd experienced mindfulness and meditation in a space designed for a specific culture, and he knew the same sort of space should exist in medical care. Spora's care model was also informed by Miller's interactions with the US healthcare system as a patient.

Most of Spora's healthcare providers are people of color, and all its clinicians are trained in health equity and cultural competence. The company cares for thousands of patients in more than 22 states and plans to expand to the rest of the US this year.

Miller was recently named to Insider's list of the 30 young leaders who are forging a new future for the healthcare industry. He spoke with Insider in a new interview about his path to founding Spora, how he's eliminating inequities and disparities in healthcare, and his experiences with bias.

This interview has been edited for length and clarity.

How did you get to where you are today?

Through a lot of trial and error. I knew at an early age that I wanted to be a business owner. I was around friends and family, and in a neighborhood in my town, a lot of folks were business owners — small businesses — that left an influence on me.

As part of the Great Recession, I got exposed to working at a startup for the first time and absolutely loved it. It was the first time I'd been in an environment and around other people that were super excited about the things that I organically cared about. They really were interested in the internet, computers, and building businesses around that.

After working at the Ladders for a year, year and a half, I started my first company. That was not successful in a commercial sense, but I learned a ton, and it was an experience that was extremely fulfilling.

That sort of environment really motivated me to try to be my best. I did that over and over and over again for a decade until I got here to Spora and am starting to find some growth, and things are really clicking.

People who work in healthcare have all been patients, too. How has your experience as a Black patient in the US healthcare system informed what you built at Spora?

I had an incredible Black doctor growing up, my optometrist.

I was at my friend's house, and he had a water-balloon launcher. I was holding one side of the launcher, and we have this thing stretched almost to the max. I have it wrapped around my shoulder, a friend was holding the other side, and after the third person that was operating the contraption lets go of the water balloon, my friend lets go of his side and this thing whips around and hits me directly in the eye. I had a gash in my eyelid. I was blind for the rest of the day.

We needed to have surgery to replace the lens. My doctor who did the surgery ended up being my optometrist afterwards. He's a Black doctor, and I just noticed that my parents were different with him.

My family physician was a white male. I'm looking at that experience versus the experience with my optometrist, and it was just noticeably different, a lot more laughter, openness. There was just a bit more warmth in the room.

When I was thinking back to how I want folks to feel, I was thinking about my own primary experience. I was thinking about my parents and how they interacted with [my optometrist].

You wanted your patients to have that kind of warmth and familiarity when they were interacting with their own Spora doctor.

Precisely.

Spora is focused on eliminating bias. Can you talk to me about why that's important, especially in relation to healthcare outcomes and how you're going about eliminating it?

I've gotten this question a lot from day one: "Why do folks of color need primary care uniquely designed for them? We're all the same inside."

Yes, we are all the same inside.

However, that lacks nuance and understanding that we don't exist independent of our environment's social constructs. Those impact our healthcare experiences, the healthcare providers we have access to, how we think about managing our own health, the information we have access to. That's the reason we find ourselves in an environment where there are inequities and disparities. Living in a racialized society is the reason that we need to think about addressing biases in healthcare.

We address the bias that's present for our patients in a few different ways. One is by creating a differentiated workforce. We want to set our doctors and our providers up for success when they're interacting with our patients. We make sure that our providers have the tools to address inequities and disparities and address their implicit and explicit biases, in some cases before they meet any of our patients. Empirically, we are creating behavior change within all of our providers, whether they're folks of color or not, to provide more culturally competent care for our patients.

As a Black founder and CEO in a very white-male-dominated healthcare industry, have you ever felt dismissed or made to feel like you didn't belong in your journey to building a company and raising funds for it? If so, how did you handle and overcome it?

Without a doubt, I have felt dismissed not only in fundraising activities but also in interacting with folks when we try to sell to enterprise partners. We talk to many Fortune 100 companies, some smaller companies as well, across the US. Some have replied explicitly that: "I don't think our company culture is ready for something like this."

Additionally, once women and folks of color reach that higher bar, they tend to be viewed as threatening. My experience has most certainly been consistent with that extending into fundraising. When I was out fundraising for those first two rounds, folks didn't believe that we could do what we said we could do. They didn't believe that it was a problem because they may have talked to their one Black friend. This is a true story. I talked to an investor, who said, "I talked to a friend of mine who's Black. I showed him the site, and he didn't get why he would sign up for this."

To see these same investors talk about equity and health equity, in particular, being extremely important for them publicly — it hasn't shown up in the data. I have a hard time believing that it's because of a lack of quality in the market. And we're starting to see a lot of companies that are focusing on health-equity initiatives either shutting down or rebranding and merging with other companies but really just running into the challenges in fundraising.

It is a very opaque, bias-driven process — startups raising from venture capital. So, undoubtedly, we're going to continue to have inequitable outcomes when it comes to companies that get funded that are led by founders of color and women until we get more transparency about the processes, what are the benchmarks for success, etc.

I've had in the last year and a half investors lie to us about or quickly change their mind about either investing or how much money they're going to invest, saying they're going to do one thing and not doing it. There's no way for founders to push against that sort of behavior.

How do you handle that? Do you just keep your head down and keep working and hope to find investors that believe in what you're doing?

Precisely. You have to look at fundraising as a numbers game. I've been able to quickly learn whether we're talking to an investor or potential partner who's really interested in investing as quickly as possible, who's information seeking, who's just sort of taking the call as a checkbox just to say they're looking at a health-equity company. You have to be discerning around who you give access to your time but also try to have a high bar and a high filter for vetting certain investors.

I think entrepreneurs also need to spend time thinking about who they would and would not accept money from, which is sometimes a hard process to go through. But it's extremely important for founders to put themselves in positions in the future where they might need support: What sort of investors do they think could best provide that support for them?

Since you've built a company and you've had some success, do you feel a responsibility to mentor? How do you think about and approach mentorship?

I do think a lot about mentorship and feel called to share my learnings with those folks behind me but also folks that are ahead and above and that are further along in my journey, if it's applicable. I made this decision when I moved out to the Bay Area over a decade ago. Having grown up in the tristate area really close to New York, I was in very diverse environments my entire life.

Moving to San Francisco and Silicon Valley, especially in tech, I did see that it was socioeconomically very segregated. But I knew there was a lot of demand and interest from Black folks that I would meet in the community. I set the intention to make sure that my story could be as public as possible, because for me, when I was growing up, I didn't have sort of reference points. I didn't think that software engineering, as an example, was a profession.

When I think about mentoring, if there are folks that I'm further along in the journey, and they're looking for support, I'm absolutely available, whether it's monthly calls or via email. But I also think about making sure that I'm learning from the folks ahead of me as well. Just getting some raw feedback around what Black founders experience is incredibly helpful because the path and the journey is opaque, and often it's tough to find the right information that you can trust.

There's so much research that shows racial disparities continue to exist in healthcare. Pick your health condition, and there's a study showing a big gap in outcomes for white people versus people of color. Do you think US healthcare is making meaningful progress in this area? Or are we still taking baby steps?

I think both are true. I don't think it's a small accomplishment for a company like Spora to exist, or Cityblock, Folx, Tia, Plume, or formerly Hurdle.

We saw a lot of growth from 2020 to 2023, and I think it's because the conditions that we found ourselves in really sort of opened folks' eyes. It took coordination but also intention, not just from innovators and the private markets but also from incumbents and payers and other folks across the healthcare system to lean in and want to change things.

And we are starting to see change, and I do think the fact that that is happening is meaningful. But I also believe that there have been largely baby steps that have been taken so far because this is a very large, complex issue that we're dealing with.

There's a lot more work that needs to be done. It's going to take more stories being told about the experiences of patients, providers, and innovators as well. It's going to take a lot of coordination and policy being created by folks at a local and federal level for us to really make this something that was part of our history and not our presence in the United States.