Instacart CEO Fidji Simo Knows That Food Is Medicine
Many people believe America’s health problem started as a food problem.
Today, more than one in 10 Americans do not have reliable access to nutritious food, and more than 100 million people in the US suffer from diet-related diseases.
Studies have shown that good nutrition can promote positive health outcomes, and medically-prescribed diets have proven to work in reducing common conditions, like hypertension and diabetes.
Yet, food as medicine programs have struggled to scale and often it's easier for doctors to prescribe medication than it is to prescribe food. So can technology help?
In this episode we talk to Instacart CEO Fidji Simo. After recognizing Instacart’s role as a staple in millions of households and at the intersection of food and health, she helped launch Instacart Health, focused on nutrition security, making healthy choices easier, and scaling food as medicine programs to help people live healthier lives.
Topics covered:
How grocery technology and delivery can promote nutrition security and health equity
Bringing SNAP online and working with food banks to get food to those who need it most
Why now is the time for the Food as Medicine movement
Multigenerational health, and the importance of healthy food habits from a young age
Her story from being a first-generation high school graduate in a fishing village in France to Silicon Valley
The biggest roadblocks she’s facing and why she’s optimistic
Listen
Transcript
Halle: I think a lot of people see grocery delivery as a luxury. Can you tell us how grocery technology and delivery can actually promote nutrition, security and health equity?
Fidji: Absolutely, and I think that's really at the heart of what we're trying to enable with Instacart work. We're trying to make the service as accessible and as affordable for, all Americans. And right now we reach 95% of the US with fresh food in under delivered, in under two hours. And so in terms of, you know, providing access to that nutritious food, We've already really covered all of the US including 93% of food deserts.
And so we really obsess over having the service as accessible as possible in terms of affordability. That's kind of the next step. And we have put in place a lot of different ways for people to be able to afford grocery delivery. A good example of that is, We were a pioneer in bringing the SNAP program online, the food assistance program in the us and that has resulted in millions of people being able to purchase their groceries online using SNAP benefits.
And that's really important because, you know, when you look at these lower income communities very often are trying to pack two jobs in one day. So don't have access to a car. And so the idea of having, being able to skip the trip to the grocery store and getting groceries delivered is incredibly important and almost even more of a value add for these populations than for the, you know, higher income population that we typically associate grocery delivery with.
And so, this is just one example of, of what we're making, what we're doing to make the service more affordable. but going forward, we think that it will require even more actors coming to the table, like payers, like providers to also be part of the solution of, of making grocery delivery more.
Halle: So for listeners who aren't familiar with SNAP, it is the largest federal nutrition assistance program for low-income individuals in the US. Something that's top of mind right now for a lot of folks is that there's an upcoming expiration of emergency SNAP funds. Can you tell us about what's happening?
Fidji: Yeah, absolutely. So, on March 1st, 32 states are ending some of what's called the emergency funding for snap. And so that means that for SNAP recipient, the budget for grocery is gonna be reduced by about $95 a month. And. As a result of that, food banks are anticipating a big rise in volume in March from families needing more assistance as a result of these changes.
And that's made even harder by the fact that food banks are already struggling with rising food prices and therefore the, the ability for food banks to acquire Stock ups our shelves in a, in a manageable cost. And so as part of that, we are launching a a program called Community Cards, which we did during the holidays, but we're expanding now because of what's happening with SNAP benefits, where any.
Person that comes to Instacart can contribute specific food items to a network of food banks from Feeding America. And the food banks are determining a set of items that the most need to stock up on their shelves. And an individuals visiting Instacart. Psy items that, that they wanna donate among that list.
And our shop personal shoppers go and deliver these items to food banks directly. Another thing that we're doing as part of this very big change is that, We are expanding or discounted Instacart plus membership for people on SNAP benefits. And this is something that you know, allows you to get free delivery on your orders and we are allowing snap bene beneficiaries to purchase this membership for 50% off for the next year compared to other, other.
Halle: Yeah. So going back to people thinking grocery delivery is a luxury, you're making it more of a sliding scale. So not everyone has to pay the $9.99 a month membership.
Fidji: Yeah, like for, for regular you know, people, it's, it's $9.99 a month or $99 a year,. And then for, for Snap beneficiaries, we're making it $5 a month for the next 12 months. So, to your point, this is this is really a sliding scale. Because a good example of that is, you know, if we, we launched recently the ability for people who really value convenience of our price to pay an extra $2 for a faster delivery.
Meanwhile, if you value price of our convenience, we actually credit you back to dollars. If you if you are okay with receiving a delivery, Day or during a, you know, three hour slot. And so that allows us to really serve all of the us which is interesting because if you look at, you know, the demographics of Instacart three years ago, it was primarily for affluent audiences.
And now if you look at our demographics right now, it's actually mirrors the split of us population pretty closely. And that's a result of all of the programs we've put in place to make the service more afford.
Halle: So tell us about launching Instacart Health and you guys collaborated with the White House on the conference and have been, you know, leading the way in terms of accepting E B T and snap. Tell us. Well, Instacart Health, I mean, you're building a healthcare company now.
Fidji: I, I think we see ourselves much more as a, as a technology department, as a healthcare industry. But fundamentally, you know, when I joined Instacart, it was so obvious to me that we are at at the heart of the relationship that people have with food. And, you know, food is medicine. So fundamentally you are at the heart of the relationship that people have with their.
And I really believe that house starts in the kitchen. And so the launch of Instacart house in September was actually something that I felt very strongly about even before taking, taking the job. And so, it's been really interesting to see just in the last six months the traction that we've had.
Payers, providers, employers, nonprofits, really wanting to leverage Instacart to scale all of their food as medicine programs. Because food as medicine has been, you know, something that's been talked about since the sixties at this point are very few people arguing that health. Starts with, you know, a healthy diet.
But when you look at what the healthcare industry has been able to do to actually embrace preventative care and really scale these programs, it's been, you know, really disappointing to be honest. And a big part of it is because, you know, if they wanted to scale these programs, They would've had to partner with a lot of retailers because, you know, people want the dignity of choice.
And so that's very hard to scale for a, you know, given hospital system or even a given payer. we provide that. We have already, you know on our platform, we already have a thousand plus retail banners. We deliver from 80,000 stores. So we already come to these payers and providers. Amazing infrastructure that really allows them to scale these programs without having to you know, do it in a really subscale way.
Like, you know, we've seen some providers sending one of produce boxes to patient and, you know, that's, that's great as, as a first. step, but that's not the kind of thing that's gonna provide a long-term sustainable change in behavior and is gonna scale to, you know, many millions of patients. So what we provide is really scaled solution for both payers and providers to do so.
Halle: So I had Michael Moss, author of Salt, sugar, fat, and Hooked on the podcast, and he is an investigative journalist who talked about how big food companies have literally got us hooked on junk food and how this has disproportionately impacted low-income individuals. How can you or how can technology help people make better food choices?
Fidji: Yeah, so that's really interesting actually because we did a study with No Kid Hungry which showed that on average online shoppers spend more than $5 more on fruit and vegetables compared to in-store shoppers without even increasing their total grocery bill. And, and by the way, Also applies to people who are on SNAP benefits.
So even lower like that, that holds true even for lower income populations. And when I started digging into why on earth would that be the case a lot of times it comes down to the fact that people can better manage their budget online. And so they know that they're not gonna exceed a particular weekly budget that they have for grocery, and they are able, as a result, to feed in fruits and vegetable.
Part of that diet and maybe take out a couple of other things that, were less healthy. And and so that's, that's been really enlightening to see that by just, you know, giving this simple tool of bus budget management, you can actually End up with, with better health choices. We also are investing a lot in inspiration and education.
So for example we have made a lot of partnerships with publishers. Like a good example is Hurst to bring health. focused recipes on the platform that you can then purchase the ingredients the ingredients to make the recipe in just one type on Instacart. So that has also been you know, really helpful.
We have created a product called shoppable carts where health experts and influences can create these curated cards. you know, if imagine you. Low sodium lifestyle or you know, what to eat if you have diabetes where you can literally purchase again in, in one tap. And then we have also added health labels.
So like, you know, gluten-free, dairy free across half a million items in our catalogs so that people can sift through products more easily to find what they need. And our core principle across all of that, We don't wanna be in the business of telling people what to eat. That's something fundamentally personal.
And we don't think that, telling people this is good and this is bad really really helps, but we think that we can inspire them and nudge them towards you know, healthier outcomes. Especially if we bring, you know, experts and influences that they trust on the platform and, and inspire them to make these.
Halle: Yes. I love that. And the recipe section, which is. Very prominent in the app is almost reminds me of Pinterest. You know, you see these really beautiful food photos. Some of them are videos and you kind of get inspired for what to eat. Are you guys making it a priority that you're showcasing healthier recipes in that recipe section?
Fidji: Yes, we are, we are definitely prioritizing that. We're also prioritizing pop-up pop-ups on our homepage. So these are basically mini stores that are curated and a lot of them have a house band. So think like, you know, your vegan favorites or lifestyle again. So that's a way. To expose people to items that they may not have thought about.
They may not you know, they may not be part of their usual diet, but help them change their diet in a really easy way.
Halle: Yeah. I love that. So you were born from a family of, correct me if I'm wrong, three generations of fishermen in France. Tell us about this amazing journey from a fishing village to Silicon Valley.
Fidji: well, you know, I was the first one in my family to even graduate from high school, so not totally destined to end up here, but clearly I had food, you know, in my d n a from the get-go. And and you know, it's been interesting being the family of fisherman because I find that the people who feed the world take.
Pride in that work. And it's such an ancestral and meaningful job. And so when I, when it was time for me to kind of decide whether I was gonna take the Instacart CEO job, I kind of was able to find a lot of. Parallels between the grocery industry and even, you know, gross grocery partners, many of who are family businesses and my own upbringing of, you know, finding so much pride in, you know, feeding the local community.
So that, that's been amazing. And then, you know, on the journey I was always fascinated by technology having. Opposed to none of it growing up, and and also fascinated by the US mostly because I was watching way too much American tv.
Halle: What shows? What shows were you
Fidji: Well, you know, I always joke that I, I picked California because I watched Z O C quite a lot and and my, in my first like flight to Califor friends to California, I literally had the soundtrack of Z O c, like, you know, California.
Here we come . And so yeah, you can, you can do more cliche than, than that, but you know, my American dream became true. And so, I yeah, I've been I've been on this journey of really trying to figure out how technology can impact people's life, but in a really pragmatic way. I, I always say that I'm a pragmatic technologist because I've seen, you know, even in the fishing industry, how.
Technology can have like very concrete, practical applications. And so I love technology, but the thing I love the most is like, how can it be applied to solve real important human and societal problems? And you know, I think nutrition is definitely one of them.
Halle: Yeah, absolutely. And and how old were you when you came to California and what was kind of your first foray into technology?
Fidji: Yeah, I think it was 2008. And and I was I was I did an, an internship at eBay in France and then begged them to you know, hired me in California. and so that was kind of my first my first technology experience. And again, you know, it was, it was not technology for the sake of it.
eBay was really about like connecting people around commerce and technology making that possible. and so, You know, fascinating, fascinating experience. And then a couple years later, I moved to Facebook and I spent 10 years there. really also focused on this idea of connecting people
Halle: yeah. A lifetime. . So we, you know, I ask this question to a lot of my healthcare guests which is that, you know, we all face naysayers in healthcare. There's a lot of negativity, a lot of. Folks who don't believe that things are going to change. I like to consider myself an optimist, and you really have to be an optimist to be a founder.
Can you tell me about some of the biggest roadblocks that you've faced in your work with Instacart Health?
Fidji: Yes. I mean, I think, you know the biggest thing is that fundamentally can see sometimes how the landscape can completely change. They're, they're, they're very focused on the boundaries they've been trained to have. And you know, nutrition is a good example. Like there's so many healthcare you know, organizations.
That really don't consider that part of their scope. They don't consider that they don't consider food to be part of healthcare. and that's a real challenge because, you know, I think a big part of the problems that we face in the US is that healthcare has really become sick care. And and not treating people to stay healthy, but really only treating them when they're sick.
And so a lot of what we've had to do is actually. educate the about the fact that things can change, in fact, and that if you take a broader view there's actually a real business case for for nutrition. You know, there's a study that came out recently that shows that if all payers were reimbursing the cost of healthy food, All diet related conditions, they would save 185 billion in healthcare cost over 10 years.
That's a massive number. And so, you know, when you take a step back and you think about this industry and incentives that drive it, I think people don't always realize that it is not. like what we're talking about here is not just doing these things because they are the right thing to do. It's also because as a massive, you know, business benefit that I wish more healthcare leaders were seeing.
But to your point on optimism in, in the last, I would say few months, very much catalyzed by the White House Conference. I have seen a change, I have seen a lot of healthcare leaders actually embrace some of these ideas and realize that change is possible. And we're seeing it in particular in the Medicare and Medicaid space, which has to be innovative, obviously given the setup and ha they have to think about preventative care.
And so we're, we're starting to see a shift in that direction and my hope is that more healthcare organizations join.
Halle: Yeah. I mean one of the issues is that the health plans, if, if it takes 10 years to kind of see that roi, someone else might be benefiting from it. So they're not going to make that investment. But when you look at Medicare, Medicaid, It. Someone might be on, on that path for a lot longer so they could recoup the investment.
Fidji: Yeah.
Halle: think we fixed that?
Fidji: You, you are absolutely right. And we hear that pushback so many times on, on the fact that you know, no, no one wants to be the first mover just in case . so you know, these people move. I think, you know, it is really about payers realizing that if they actually. All move together in this direction at the same time it will, it will actually result in massive business benefits for them.
And I think, you know, they're starting to realize that, they're also starting to realize that employers are looking for these benefits. And, you know, obviously employers have a lot of SW with payers and more and more employer. Thinking about you know, how to keep their workforce healthy, happy, well fed, , and and demanding more more work in that direction, which I think is gonna be a good pressure point for the ecosystem.
Halle: Yeah. Yeah, I hope so because I, I, I agree that this is something where if we could get the health plans, the providers on board, then it makes, you know, the technology can fuel making this happen. But having those who are actually running the system buy in is, is critical. Yeah.
Fidji: It is very clear that if someone is food insecure, feeding them is gonna result in better health outcome and honestly, No one is pushing back on that anymore, but when you look at food as a way to help improve chronic conditions, whether it's, diabetes, et cetera There's, there's a general acknowledgement that of course it's gonna have a positive impact, but there's not a lot of precision.
Meaning like, you know, if you go to a doctor right now and you have, you know, particular health conditions, doctor is gonna be able to prescribe a particular pill at a specific dosage, at a, you know, specific time of day. We don't have that for food. We don't know if we should be giving you. X amount of vegetables for that condition.
How long is this benefit does this benefit need to be funded for, to create real behavioral change over the long run? And all of these questions are still a little bit unanswered, and so we're seeing a lot of, you know, providers and payers. , embrace that and not wait for all of that data to come in and run a lot of pilots and tests, which is encouraging.
But fundamentally, over the long run, we need to solve these questions and have real food formularies so that we know exactly what to fund, at which moment in time to, to best benefit us outcomes.
Halle: Oh, so I'm not sure if you've seen these photos of school lunches around the world but I'm pretty sure the, the lunches that I had in public school in Ohio looked different from what you were having in in coastal France. what are your thoughts about how we feed our children and what we can do?
Fidji: I mean, the thing that's really crazy to me is that childhood is such a critical moment both for, you know, long term health outcomes, but also. Long-term healthy behaviors like these are, this is a moment during which we're training children on, healthy habits and how they're gonna feed their families over the long run.
And at Instacart, because we're so embedded with, you know, family life, we think about multi-generational health. And if you miss this moment of you. Teaching kids about healthy food habits that's, that's a pretty pivotal time that you've missed. And so, obviously, you know, I'm, I'm even more biased coming from a, from a French background where we were incredibly spoiled with, with good food growing up.
But but yeah, I do think that you know, what we should, should our, our children is, is critical and schools have. Massive role to play there. And I mean, we've, we've seen the role that they have, especially with food insecure families in, you know, making sure that children are well fed and, you know, having healthy food as part of that is critical.
And and, and, you know, this is not the only place where this kind of. interesting situations happen if you look at hospitals, like the food in hospitals also tends to be pretty terrible. Like in fact we, we, when you look at the studies, like staying at a hospital increases malnutrition rate and that's pretty crazy when, you know, we obviously believe that food is medicine.
Hospitals should be also the place where we teach you about how to eat healthier and how to have, you know, better food. And instead we're making you even worse you know, in, in this setting. So I think there's a lot that can be done through schools, through hospitals to you know, use these moments to teach better rabbits.
Halle: Yeah, I as I said, I grew up in Ohio and in Cleveland where we have the Cleveland Clinic, a world-class hospital. But it had a McDonald's in the lobby until pretty recently. They finally, I think, realized it was sending the wrong message. but yeah, I think we need to have, have these conversations everywhere about how how we're feeding our.
let's switch gears and talk about one of my favorite things, women's health. You, on top of being c e o of Instacart, recently helped found and launch a women's health company. Can you tell us more about this?
Fidji: Absolutely. So about you know, three years ago I was diagnosed with a neuro immune condition, which is basically a condition at the intersection of the nervous system and the immune system. And I realized that the level of care for these conditions which primarily impact women Really terrible and the scientific research around this condition was chronically underfunded.
And so I found two amazing co-founders, Dr. Laura and Dr. James Hemp, and we decided to create Metro, which is a. Large scale medical and research center based in Salt Lake City dedicated to these conditions. And the real innovation there is that we're really bridging clinical care and scientific research all in one building with clinicians across specialties are collaborating with researchers and s.
On, you know, developing the past cures while also providing patients with the absolute best level of care for these conditions. And as you know, many people know when you have some of these conditions that affect multiple body systems, you are basically bouncing around, usually from specialist to specialist and neurologist, or GI doctor or rheumatologist.
No one knows what's going on with you. No one has the full picture. And so we really ask ourselves these questions of like, what would healthcare and scientific research look like if it was reinvented from the ground up for collaboration? And so the entire building itself, 60,000 square feet of state-of-the-art medical clinic is entirely designed for collaboration between different specialties of medicine, between clinicians and researchers, and even collaboration with patient.
Halle: And why Utah not California?
Fidji: well, we looked at many different places and so things that was interesting is that this is a destination medical clinic think, you know, similar model as Mayo. And we wanted people to be able to come in from, you know, all across the country. They stay with us from between one to three weeks. and so we wanted a very.
Easy you know easy to city to get to. And Salt Lake is the second city in the US that's like the most flight flying in. And so that was, that was a big reason. The second reason is that this is actually a big hub for biotech. And so, you know, we're literally down the road from Recursion and, and other leading biotech companies.
and so. Also been, you know, very helpful as we build, not just the medical center, but really an ecosystem of biotech companies around it.
Halle: Amazing. So what are some of the opportunities that you see for innovation? In healthcare, whether it's women's health, food is medicine, or another area that excites you.
Fidji: And by the way, before I answer your question, I just wanna touch on one point that, because you, you called it women's health and. You know, it's been really interesting because when we launched Medora, we actually decided to not call it women's health. And I'll tell you why. Like, even though you know, 80% of our patients are gonna be women the reality is that there's still this belief that when you say something is women's health.
People assume it's reproductive health. It's almost as if they assume women have only one organ. They're uterus, . And it turns out, you know, women have a lot of different organs and what we're doing is not reproductive health. It's, it's really, you know like health condition that, that impact multiple body system.
But it's been so interesting to me to realize a bias that people have. Really associating women's health with, with reproductive health, when in fact there's such an untapped market and an untapped potential of really thinking about healthcare in a different way for women because, you know, their immune system behaves differently.
They have like so many other differences than just a reproductive organ. So I just thought that was, that was important.
Halle: Yeah. It's funny, I just posted something on that topic about how we have to move beyond just thinking about women's health as our, our body parts and more about. Unwinding the entire patriarchal system, healthcare system that has been built by and for men. And so actually a lot of it is more, a lot of the issues that we face are more challenges, systemic challenges that, that have nothing to do with our reproductive systems.
But the fact that test dummies. look like men. And so they're, you know, they're the size of men and so women are more likely to get injured in car, car accidents and whatnot. But I, I do agree with that. And I think why I am drawn to use the wo the word women's health for your company is because I love to see more spaces that are created by women for women in a way that is not. Say, like, shrink it and pink it. Like, anytime we have something in this space, we wanna make it for women. We just like, you know, make it smaller and, and color it pink. Versus actually think through the, the entire experience, the whole body experience that a woman has.
Fidji: Yeah. I, I so agree. And in fact, you know, it goes back to the last question you were asking me on, like, what do I see as a big, big opportunities? In my mind, if you look at scientific research, we've kind of reached a diminishing returns, I would say, with the way we're doing it, by focusing on each of these organs.
You know, like it's scientific research on the heart, scientific research on the brain. I think the next stage of scientific research and discovery is going to be really at the intersection. So nervous system and the immune systems, the nervous system, and the GI tracts, the nervous system and the endocrine system.
And a lot of scientific research right now is not done this way. And I actually think that a lot of the conditions that primarily impact women, auto autoimmune conditions, neuro immune conditions, are really these condit conditions that are about the interactions between all of these body systems that we do not understand.
And so, I think that by focusing on that, even, even though right now these are women the condition that primarily impacts women, we're actually going to be making scientific discoveries that impact men as well, because there's very limited understanding of the, of the interactions between all of these systems.
Halle: How are you educating yourself and getting up to speed on medicine? Given your background is in technology, but now you've launched a company in the the medical clinic and research facility, what are you doing to kind of get up to speed and get your you know, your MD in this?
Fidji: Well, I'm far from an MD, but I'm incredibly curious and, and you know, on top of that, when you have one of these conditions yourself and you know, these conditions have a component, so I really wanna. Avoid you know, my daughter getting one of them. Like, it creates even more motivation to learn.
And so when I got started on you know, building Metro Door, I actually enlisted the help of Stanford students. and I took classes during my weekends in biology and biotech. And let, let me tell you like you do not want me, you know, treating patients or, or designing drugs quite yet, , but but I learned enough. I learned enough to be able to be hopeful, you know? And and a big part of the role I've played is really connecting the, the clinic and my co-founders with this incredible constellation of new technologies, bio bio technologies that take, you know, 17 years to make it into clinical practice, which is insane when there are so many advances, right?
Could be helping patients, but because as we know, healthcare is quite slow really don't make it to clinical practice in, in any amount of time. That helps helps patients and that's fundamentally one of the things that we wanna change.
Halle: Yeah, absolutely. I always say we need, we need more diverse perspectives in healthcare, and I think the systems thinking that you've learned in technology kind of brings a fresh perspective on solving age old problems.
Fidji: Absolutely. And even if you look at, Our, our founding team one of my co-founders is a MD PhD. The other co-founder is a top scientist PhD. And, you know, I'm a technologist and so even our founding team is actually a representation of our mission of breaking down the silos between clinical practice, scientific research.
and technology. And if you break down all of these silos and to your point bring in a very different perspective of how to solve this problem, you get better results. And you know, in technology, when we have a hard problem, what do we do? We just bring the best people from each of our teams across a.
Product engineering design around the table and we start brainstorming and, you know, very naively, when I got sick, I thought that that was what was going on in a care. I was like, Hey, you know, to my, my doctor at the time, I was like, are you like, you know, brainstorming with scientists and this like hypothesis?
And he was like, oh no. don't talk usually . And so you know, for, for me it was like, oh my God, like this is a problem that is so critical. It touches people's health and they're not applying the techniques that are pretty much, you know, proven for how to get the best ideas and how to, to innovate. And so that, that's why we decide to build Metro DI in a very different way, like very anchored on Collabo.
Halle: I love it. And hopefully more more folks can learn that lesson and we can be more collaborative. I think we just, we need more of that within healthcare. Our problems are too big to. To solve them in a silo. and we need as, we need as much help as we can get. So Fidji, we so appreciate your time today and wish you all the best on both of your ventures and thank you so much.
Fidji: Thank you so much for having me.