Skip to content

Cart

Your cart is empty

Continue shopping
Josh Rome, founder and CEO of Runway Health, on the Honest Ecommerce podcast
Jan 23, 20236 min read

B2B2C Customer Acquisition Strategy for DTC Health: Runway Health

A Market Bigger Than ED and Hair Loss Combined

Travel health as a category is larger than erectile dysfunction and hair loss combined. That single data point is what convinced Josh Rome, founder and CEO of Runway Health, that he was looking at a genuine blue ocean. Companies like Hims, Hers, and Roman had already shown that DTC telehealth could scale into multibillion-dollar businesses targeting those conditions. Travel health had no equivalent player, and Rome had the pharma industry background to know it.

Runway launched in May of the year this conversation was recorded as the first direct-to-consumer telehealth brand focused exclusively on travel health prescriptions: malaria prophylaxis, motion sickness medication, altitude sickness medication, antibiotics for traveler's diarrhea, and sleep aids. The problem it solves is real. Between 20% and 50% of travelers going to developing countries will encounter traveler's diarrhea at some point, and the existing options for getting proper medications before a trip are fragmented travel clinics or a primary care physician visit. Roughly 35% of millennials do not have a PCP at all.

How Rome Built Runway Without Building Everything From Scratch

One of the more practical decisions Rome made early was choosing not to replicate what the first generation of DTC telehealth companies had to build. Hims and Roman needed to construct their own physician networks and form pharmacy partnerships state by state. By the time Runway launched, a mature vendor ecosystem already existed. Rome plugged into partners already licensed across all 50 states for both telehealth services and pharmacy fulfillment, which let Runway go national immediately without the capital intensity of building that infrastructure internally.

The trade-off is margin. Using third-party vendors compresses margins compared to owning those relationships. Rome is explicit about this: the current phase is about gaining traction and proving the concept. As the business scales and raises additional capital, the plan is to bring some of those vendor relationships in-house to improve unit economics over time.

Why Runway Skips Paid Ads in Favor of a B2B2C Partner Network

This is where Runway's strategy gets genuinely different from most DTC brands. Rather than funding growth through Facebook, Instagram, or Google search, Rome is building a B2B2C model: partnering with businesses that are already selling to his target customer and having them refer travelers to Runway at the point of highest relevance.

The logic is straightforward. A travel agent booking an African safari already knows their client is heading somewhere that requires malaria medication. A tour operator finalizing a Machu Picchu itinerary knows their client may need altitude sickness medication. A travel insurance company selling a policy to an outbound traveler has a natural reason to mention travel health medications. Each of these is a warm handoff to Runway at the exact moment the customer has a clear need.

There are roughly 150,000 individual travel agents in the United States alone, plus tour operators like Abercrombie and Kent and andBeyond, plus travel insurance companies. All of them are potential distribution partners, and Runway compensates them through an affiliate structure, meaning customer acquisition cost is paid only when a transaction occurs. Some partners have asked Runway to redirect those commissions to conservation efforts they support, which says something about the quality of alignment in these partnerships.

Rome contrasts this directly with what most DTC health brands are forced to do. Paid social costs continue to rise, Apple privacy changes erode efficiency on a recurring basis, and the resulting business often has no clear path to profitability. Oova pursued a comparable B2B2C approach, growing to 88 clinics without paid ads, which shows how health brands with a natural referral layer can sidestep the paid social treadmill entirely. With the B2B2C model, Runway is designed to generate profit on customers from day one, because acquisition cost is a percentage of revenue rather than a speculative upfront spend.

Defining Your Own KPIs When Your Business Model Is New

Because Runway's growth engine does not look like a standard DTC funnel, standard DTC metrics do not fully capture what matters. Rome is tracking what he calls ATT: annual traveler touch points. This measures how many times Runway's service is presented to a traveler through the partner network in a given year.

The math behind it is simple. If the partner network generates 2 million annual traveler touch points and Runway converts even 0.25% to 2% of those, the resulting volume builds a sustainable business at a customer acquisition cost that paid channels cannot match. At 5 million touch points, even conservative conversion rates produce meaningful revenue.

Building this metric from scratch creates its own challenges when talking to investors and partners who are accustomed to ARR, MRR, and CAC. Rome's near-term priority is generating early case studies that demonstrate the model working, so those conversations become easier.

Operating Philosophy: Small Bets Over Big Risks

Rome is transparent that Runway is his first DTC venture. His approach to that reality is to run many small experiments simultaneously rather than committing large budget to any single strategy before it has proven itself. The goal is to move quickly toward what works and away from what does not, without a single failed bet threatening the business. Hims co-founder Joe Spector took a similar learn-by-doing stance when he launched Dutch on Shopify, and his perspective on building a second DTC health brand from scratch offers a useful contrast to Rome's position as a first-time founder entering the same space. For a company still in its early proof-of-concept stage, that capital discipline matters as much as any marketing tactic.

Key Lessons From This Episode

  • Being second or third to market in a category is often an advantage. Early pioneers build the infrastructure and absorb the capital risk; later entrants plug into an existing ecosystem and scale faster with less money.
  • A B2B2C affiliate model can replace paid social and search entirely for brands whose customers have a natural relationship with other businesses before they discover the DTC product.
  • Structuring customer acquisition as a revenue-share rather than upfront spend allows a brand to be profitable on day one instead of subsidizing growth with capital that may never return.
  • When your business model does not fit standard industry KPIs, define your own. The metric that matters is the one that actually predicts whether your specific growth engine is working.
  • Managing budget through many small experiments rather than a few large bets reduces the risk of a single failed strategy doing serious damage during the early stages of a new business.

Hear the full conversation with Josh Rome, including his path from travel newsletter to boutique agency to telehealth founder, in the transcript below.

In This Conversation We Discuss:

  • [00:00] Intro
  • [01:09] What products does Runway offer?
  • [01:41] How Josh realized the opportunity for Runway
  • [04:09] The “real genesis” of Runway
  • [05:55] Pioneers bear so much risk
  • [07:15] Choosing partnerships over self-production
  • [08:07] Sponsor: Electric Eye electriceye.io/connect
  • [09:03] Sponsor: JSON-LD for SEO jsonld.app
  • [10:18] Sponsor: Wayflyer wayflyer.com/ecomm/honest
  • [11:21] Runway’s go-to-market strategy
  • [13:43] How Runway compensates their partner network
  • [15:52] Partners can value things other than money
  • [17:17] Experiment and don’t be afraid to fail
  • [18:01] The benefits of being first to market
  • [19:35] Coming up with your own relevant KPIs
  • [20:29] Where to find Runway products

Resources:

If you’re enjoying the show, we’d love it if you left Honest Ecommerce a review on Apple Podcasts. It makes a huge impact on the success of the podcast, and we love reading every one of your reviews!

Share

Transcript

Chase Clymer  

Before we get started, if you're enjoying this content, you can do us a favor by subscribing to our YouTube channel and ringing the bell.

That will let the algorithm know that you like this content and it will help us produce more.

Josh Rome  

For us, what's most important is that we are experimenting regularly, trying a lot of different things, [and] not being afraid to fail.

Chase Clymer  

Welcome to Honest Ecommerce, a podcast dedicated to cutting through the BS and finding actionable advice for online store owners. I'm your host, Chase Clymer. And I believe running a direct-to-consumer brand does not have to be complicated or a guessing game. 

On this podcast, we interview founders and experts who are putting in the work and creating  real results. 

I also share my own insights from running our top Shopify consultancy, Electric Eye. We cut the fluff in favor of facts to help you grow your Ecommerce business.

Let's get on with the show.

Hey everybody, welcome back to another episode of Honest Ecommerce. I'm your host, Chase Clymer. And today, we're welcoming to the show, Josh Rome

Josh is the founder and CEO of Runway, the first D2C, direct-to-consumer telehealth brand focused on travel health. Welcome to the show, Josh. 

Josh Rome  

Hey, Chase. Great to be here.

Chase Clymer  

Oh, it's gonna be fantastic. So for those that are unaware, can you just let us know what it is? A telehealth direct-to-consumer brand? What kinds of products are you guys bringing into the market?

Josh Rome  

Yeah, so we're the first company focused exclusively on travel health. So when I talk about travel health, I'm referring to prescription medications that you take for many of the most common travel ailments. 

So that includes things like malaria, prophylaxis, motion sickness medication, altitude sickness medication, even things like antibiotics for travelers, diarrhea, and sleep aids.

 Any prescription medication product that you might need to take along with you on your travels.

Chase Clymer  

I know that this is a really common problem when you're going to --and I hate to say this but-- third world countries or people or countries that do not have an advanced health care system. 

Is that correct?

Josh Rome  

Yes. So something like traveler's diarrhea is probably the most common travel related ailment. 

20% to 50% of travelers traveling to developing countries will encounter traveler's diarrhea at some point in their lives, in their travels.

Chase Clymer  

Awesome. Alright, so just take me back in time. We're gonna through all of this, particularly to this idea [that] comes from what was going on in your life. 

What was the catalyst for like, "You know what? I think there's an opportunity here." 

Josh Rome  

For sure. So my career spans the tech pharma and travel space, so I feel uniquely well-positioned to tie this all together with Runway. 

But after a successful exit from the pharmaceutical industry in 2019, I had an opportunity to try to better align my career with my passions. So I've been an avid traveler my entire life. 

I've been to over 60 countries and went on a program called Semester at Sea for a study abroad program. I've climbed mountains like Kilimanjaro, and Toubkal in Africa. Travel has just always been this really defining characteristic of my personality. 

So with that, looking to rebrand my career, I started a daily travel-based newsletter called CitySpeak.

I grew that to a few thousand subscribers, and then ultimately leveraged that user base into opening up my own boutique travel agency. 

I affiliated with one of the largest agent networks in the US, a company called Protravel, and started managing itineraries and selling travel throughout the world. 

So through that experience, I identified this gap in the industry. And that was after booking a honeymoon in Bali, or a family going on an African Safari or a father and son that were flying to Machu Picchu.

I would always get asked these questions related to "What types of medications do I need for my trip?" Or "What types of health concerns should I be aware [of]?" 

And at the time, all I could really do was refer them to either their primary care physician or suggest that they visit a travel clinic. 

I'm 36 years old. I don't actually have a PCP. 35% of millennials don't. And the Travel Clinic industry is highly fragmented, it's notoriously costly, and overall, a poor consumer experience in today's day and age.

Chase Clymer  

Oh man. This is gonna be such a fun conversation. 

So you saw this gap in the market and you decided "There might be an opportunity here." 

I would say that healthcare is probably the most regimented industry, maybe only surpassed by finance. How did you... 

What was the first step like getting into this and trying to just figure out if this is a good idea or not?

Josh Rome  

Yeah, so a couple things. I leveraged some... Once the initial seed was planted, I leveraged some of the initial insights and access to data I had from my former life in the pharma industry. 

And I would say the real genesis of Runway was when I uncovered that this segment of the healthcare industry that was branded or called "travel health" was actually larger than both erectile dysfunction and hair loss combined. 

So I'm sure you're familiar with companies like Hims and Hers and Roman and the way that they really were able to pioneer DTC telehealth for initially men's wellness, growing that to women's wellness, dermatology, mental health, etc. 

Identifying this gap in travel health and feeling like there was a blue ocean approach to a potentially larger market than what some of these other companies were building. 

When I started thinking about really putting the pieces together to actually intangibly build Runway... 

So, we live in an environment and with an ecosystem that's very different [from] what some of those early pioneers had to manage. So they had to build out their own physician networks, they had to form partnerships with various pharmacies. 

Today, there is an entire ecosystem of vendors, frankly, that allow smaller startups to integrate into the market much quicker and also allows them to scale much faster. 

So we're using partners for things like our telehealth services, which allows us to launch into all 50 states rather than building out a state by state network. 

Similarly, we're working with a partner pharmacy that is licensed in all 50 states and they can ship our medications to patients throughout the US. 

These are opportunities that were afforded to us because of the telehealth ecosystem that has been built up over the past 5 years and beyond. 

And really gives us and many other companies entering the space today an advantage over some of those early adopters.

Chase Clymer  

Yeah, something that I read the other day, which I was thinking about the whole time you were just talking, was that the first people that go into a new market invest the most and are most likely to go bankrupt because they have to pave the way for everyone else. 

And a good proof of concept there is... 

Well not proof of concept. 

But obviously on the agency side of things, whenever there's a brand new ad platform or technology when people jump on it, and adopt it, and tie their business around it, you don't know if it's going to be there in 6 months or a year. So, it's definitely a little more risky. 

But obviously, risk versus reward. 

No one's going to sit back here and say that Hims isn't doing all right.

Josh Rome  

Totally. And it's actually funny you say that, because some of our partners and  investors have actually said the same thing to me about travel health and that we're really leading the way and travel health and we actually have a very unique and differentiated strategy towards customer acquisition that we can pave the path and pave the way. 

But as soon as we prove out this concept, there will be others following behind us potentially with greater access to capital, bigger teams that we're always going to be fighting to keep our space at the top and build out our moat. 

But there's unique challenges to certainly being first to market.

Chase Clymer  

Absolutely. And I think that one of the more interesting approaches that you have here is instead of building your own partner network, instead of building your own pharmaceutical network, you chose to go with partners. 

Now I'm just gonna guess here and you can share as much or as little as you can about this, but it definitely doesn't make your margins as healthy as possible. 

But it also helps you get to the next phase of your business a lot faster.

Josh Rome  

Yeah. And that's exactly it. Less capital intensive from the outset, allows us to get to proof of concept much faster in a much more scalable fashion. 

As we can continue to grow, gain traction, raise additional capital to take on some of those vendor relationships, bring them internal, we'll be able to have healthier margins down the road. 

Right now for us... 

We launched in May of this year. It's all about gaining that initial traction, all about building out proof of concept. And once we have that, I'm confident we can really start running with this.

Sponsor: Electric Eye

Hey there, merchant.

Are you tired of trying to navigate the wild world of ecommerce on your own? 

Are you looking for a partner to help you achieve your goals? 

Look no further than the Shopify Plus agency, Electric Eye. Our team has a proven track record of helping our clients make millions with strategic design and development.

Whether you're migrating from a legacy platform to Shopify, designing a new theme for your store, or just looking to optimize what you have, Electric Eye is the perfect partner for you. 

Electric Eye are true Shopify experts. 

Not only is our Shopify knowledge unparalleled, but we have partnerships with all the best tech in the Shopify ecosystem. 

And don't worry, we're easy to get a hold of. Our clients rave about our fast communication.

So here's the deal, if your ecommerce business is doing over $1 million dollars a year you can receive a complimentary Shopify Diagnostic from our team of experts. 

That's free, personalized, strategic recommendations to improve your store and grow your business.

To get started, head on over to electriceye.io/connect to schedule an intro call with one of our experts.

That’s electriceye.io/connect.

Sponsor: JSON-LD for SEO

Struggling to get your Merchant Center ads approved by keeping running into a price mismatching error? 

Wondering how your competitors are showing reviews, price delivery, and product availability directly in search results? 

What if there's a way to get more traffic without fighting for rankings? 

Well, that's where JSON-LD for SEO comes in. It's an app that gets you more organic traffic to your Shopify store, qualifying you for over a dozen search enhancements, and provides all of the structure data you need for Merchant Center. 

JSON-LD for SEO automatically adds the structured data needed, and it's updated regularly as the rules changed by Google. 

It's a hands off SEO app that you don't need to monkey around with to get working. 

It's the safest, easiest and most effective way to stand out from your competitors in search results. 

Contact us to get your free structured data audit for your store. Find JSON-LD for SEO in the Shopify app store to get started. 

That's J-S-O-N-L-D for SEO, or go to jsonld.app.

Free plan available with no cost setup included. 

Sponsor: Wayflyer  

It's the beginning of a new year. And with the new year comes new opportunities. 

The often misunderstood Q5 period stretches from Christmas Day to Chinese New Year and gives brands the gifts of significantly lower CPMs. 

But how can you use this Q5 as a springboard to make 2023 your best year yet? The answer is funding. Funding opens doors for your business. 

A cash injection now will enable you to take full advantage of the Q5 opportunity by investing more into your marketing and securing that spring/summer collection from your manufacturers. 

Revenue-based finance from Wayflyer is fair, faster and more flexible than the traditional funding options out there. 

You can get approved for funding and hours and cash in your account within days. 

There are no interest rates or personal guarantees, just one simple fee. 

Best of all, repayments are made as a percentage of your revenue. So if you're having a slower month than usual, no problem. You'll just give them less. 

To learn more about how funding from Wayflyer can unlock growth for your business and turn 2023 into a record year, visit wayflyer.com/ecomm/honest

That's wayflyer.com/ecomm with two M's /honest

Wayflyer. Funding a better way. 

Chase Clymer  

Now, let's just talk about building this business and acquiring new customers. What was that go-to-market strategy

How are you getting people into the pipeline to start...

Josh Rome  

Mm-hmm.

Chase Clymer  

...making some money? 

Josh Rome  

Yeah. So that's frankly the most exciting part of the business for me. When you look at competitors in the direct-to-consumer healthcare space, we've used names like Hims and Hers or Roman. 

Already, it's really difficult to build communities around health care conditions, hair loss or erectile dysfunction. 

Generally, if you're not familiar with one of those brands, you're gonna have to go to a general practitioner or PCP, chat with them about your problems, and if they determine that you're a candidate for medication, they're gonna go ahead and write you a prescription. 

And in no case is that general practitioner gonna refer you to a third party telehealth platform to get access to your medications. 

Meanwhile, --And frankly, I experienced this firsthand as a formal travel supplier-- when I was booking that trip to Bali or when I was booking that African Safari, I was the first to know who might be a candidate for medication. 

And we can leverage these travel suppliers to effectively become the voice and ambassadors for Runway to build out our customer base, to refill our sales funnel year after year, and allow us to acquire customers at a much more cost effective manner. 

So we are really trying to prove out right now this B2B2C marketing strategy rather than what I would call a traditional growth marketing strategy of paid search and paid social. 

A lot of DTC brands that you talked to today, I'm sure, are spending a tremendous amount of money on Facebook ads and Instagram ads and Google search

And what we're seeing is Apple will enact a new privacy restriction that makes the efficiencies go down, or the cost to acquire customers through Facebook is constantly --seemingly constantly-- increasing. 

If we can build our business through a partner network, we'll be able to profit from our customers day one and build a real and sustainable business, which is very exciting. 

We are seeing what's happening in the markets right now with these high growth customers that are spending a ton of money to acquire customers. 

These high growth companies that are spending a ton of money to acquire customers, but don't have that path to profitability. 

Meanwhile, Runway, as we build out our partner network, build out our community of both travelers and travel suppliers, we can build a real sustainable business and then your future.

Chase Clymer  

Yeah. That is such a unique strategy. I don't think it's a strategy we've talked about on the show before. I'm racking my brain to think about it. 

But the way I'm gonna really simplify what you guys are doing over there for the listeners sure is you are partnering with people in other businesses that are selling other products to your target demographic, as opposed to trying to acquire those people further up the funnel with awareness ads through paid search engines. 

Now, I'm also just going to guess here that with these partnerships, that it's probably an affiliate deal where you're not really paying upfront, you're only paying when things happen. 

Josh Rome  

That's correct. Yeah. And just to talk about who those travel suppliers are for us. So that can be one of the 150,000 individual travel agents in the US that are managing individual itineraries for travelers that can be tour operators like an Abercrombie & Kent or an andBeyond

That could be a travel insurance company that's selling travel insurance into a traveler after their trip. 

These are all different touch points to that traveler that afford Runway a complimentary opportunity to provide their service that also enhances the service of that original seller of travel. 

So that travel advisor, that's booking that African Safari is already suggesting that that traveler requires or procures travel insurance. They're making sure that they're all set up with their flights and logistics. 

Having them also recommend a better, more effective, more cost effective way to obtain relevant travel health medication and access to US-based physicians during their travels is an additional value add that they can offer. 

The fact that we're compensating them for it through an affiliate marketing opportunity is, frankly, just icing on the cake. 

Some of our partners to date have actually wanted us to just donate those commissions to some of the conservation efforts that they're working on. So it's interesting for us. 

Right now, we're playing, frankly, different levers seeing what is resonating most with the partners, what is most valuable to them? 

Is it purely our service? Is it that commission? Is it a co-promotion or co-marketing effort?

Chase Clymer  

Yeah, I'll even tell you on my side of things. Whenever... Running an agency, having the direct ear of Ecommerce merchants every day... 

Our inboxes are inundated with partner opportunities that run the gamut from being one sided to one of us to just being a terrible fit. And the things that are more exciting to us are actually solving a problem for our customers... 

The last thing is really the money at times, it's more value in other forms, be it co-marketing or just having someone actually help you solve a problem. 

Josh Rome  

Yeah. And especially this... 

Where we are coming out of COVID right now, we're seeing travelers travel with this heightened sense of awareness towards their health and travel. We are focused on this proactive or prepared traveler, which today is every traveler, because they're navigating so many of these different hurdles that COVID has resulted in. 

And being a support system for that proactive traveler really just elevates the experience for all and when it's coming from that trusted travel advisor or that trusted tour operator, it elevates them along the way.

Chase Clymer  

Absolutely. Now, looking back at building this business, or maybe just in your career, [are] there any mistakes or learning experiences that you can remember that you think might resonate with a founder getting into the direct-to-consumer space?

Josh Rome  

So this is, frankly, my first foray into the direct-to-consumer space. So there are a lot of new learnings. 

I think, for us, what's most important is that we are experimenting regularly, trying a lot of different things, not being afraid to fail, frankly. 

We're managing the budget in a way that we are taking a lot of smaller experiments, rather than leaning heavily into some of the seriously big risk style marketing strategies.

So for us, it's trying a lot and not being afraid to run with what's working and and walk away from what's not.

Chase Clymer  

Now Josh, is there anything that I forgot to ask you about today that you think might resonate with our audience?

Josh Rome  

One thing that I think is interesting about being the first to market with a new strategy is how we can really define and craft our own story and our own success metrics. 

So as we've seen in the SaaS industry over the past few years, it's all a focus on ARR, annual recurring revenue, MRR, and really defining success based on those metrics. 

At Runway, we're developing our own success metrics. 

So because we have this B2B2C strategy, because we are building out a partner network of hundreds of suppliers, all with the goal that we can have millions of touch points with travelers, we're building out our own metrics of "ATT" - annual travelers touch points. 

Knowing that if we can extend to 2 million or 5 million annual traveler touch points through our partner network, you can look at a conversion rate of 0.25% or  .05% or 2% or 3% of those ATTs, those annual traveler touch points, knowing that we're able to build again, that real and sustainable business through those metrics, because we're able to profit off of our customers from day one. So it's really exciting. 

It's also challenging in crafting that story and speaking with investors, speaking with partners, and getting them to understand that we have a different strategy than what they're typically used to. 

But what we are really working towards today with our recent launch is building out those first few and early case studies that we can show to the world that this model is working and will allow us to build a real and successful business down the road.

Chase Clymer  

I think that's fantastic coming up with the KPI that matters to your business. 

For most direct-to-consumer businesses, the KPIs are somewhere along the lines of AOV, conversion rate, and sessions

But with you, your business is a little more unique with what you said that business to business to customer strategy, which is so cool, and it's got my brain spinning.

But most business books that you'll read will talk about simplifying the data that you're looking at. And your dashboard, if it's more than 5 metrics you care about and if you can't see the health of your business with 3 to 5 numbers, you're doing too much. 

And I think coming up with those KPIs that truly matter to your business is such an insightful strategy for any business regardless if you're direct-to-consumer or not. 

You can be traditional or whatever,  that is such an insightful strategy. Just keep it simple, know which ones you need to look at to know if the business is growing or doing what needs to be done. 

Josh Rome  

Yeah, I absolutely agree. 

Chase Clymer  

Awesome. Josh, you've talked so much about these innovative products that you guys are bringing to market. 

Now if I've got some travel coming up, or any of the listeners are curious as to what's going on, where should they go to check it out? 

Josh Rome  

Runwayhealth.com

Chase Clymer  

Awesome. Josh, thanks so much for coming on the show.

Josh Rome  

Thank you so much, Chase. Really appreciate it.

Chase Clymer  

We can't thank our guests enough for coming on the show and sharing their knowledge and journey with us. We've got a lot to think about and potentially add into our own business. You can find all the links in the show notes. 

You can subscribe to the newsletter at honestecommerce.com to get each episode delivered right to your inbox. 

If you're enjoying this content, consider leaving a review on iTunes, that really helps us out. 

Lastly, if you're a store owner looking for an amazing partner to help get your Shopify store to the next level, reach out to Electric Eye at electriceye.io/connect.

Until next time!