Liz Reitman

5 min | Leadership & Management Musings

Founders in Focus with Vanessa Rissetto

A Conversation between Liz Reitman and Vanessa Rissetto, CEO and Co-Founder of Culina Health

Liz Reitman: Okay. Hello, everybody. I am super excited for our latest Founders in Focus series to have Vanessa Rissetto, CEO of Culina Health, which is, in a snapshot is, virtual, one one nutritional care. Welcome, Vanessa.

Vanessa Rissetto: Thanks for having me.

Liz Reitman: So, I’m really excited. I met Vanessa at an entrepreneurial organization event, and we clicked immediately. And I just find you so inspiring. I love your energy. I’m really excited to have you here. Plus, I love having female founders. That is my jam. Not that I don’t have male founders.

Vanessa Rissetto: It’s harder for us, so, you know, you can relate.

Exactly. So I guess let's just start with the very beginning. What inspired you to start Culina Health and, tell us how it all began?

Vanessa Rissetto: Yeah. We get asked this question a lot. We were, first of all, being a registered dietitian is the worst return on investment for education, per US World News report. My parents are obviously so proud to this day, and dietitians always have, like, a side hustle. So I was working at New York University, but I had a private practice, and I always took insurance. And notoriously, dietitians don’t take insurance. Or up until that point, they didn’t. So it’s just like, luxury thing, right? These dietitians, some of them were charging $1,000 a session. So if you’re the regular person, you didn’t think that you could access that. Then my co founder and I went for a coffee, and she was like, oh, do you want to join private practices? I was like, yeah, sure, no problem. Somebody else had to do, like, half the work. So we hired two other RDs. I would see patients in Hoboken, they would see patients in New York, and at the end of the year, we would pay our taxes and split what was left. But then COVID happened, and it was the first time that a telemedicine visit was being reimbursed the same rate as an in office visit. And so we grew to, like, eight dieticians made a million dollars in about ten months with no marketing, which was unheard of. Private practices. It was very difficult to scale. Right? Cause you can’t see that many people. And this allowed us the opportunity to do that. And then at the same time, venture capitalists started. And so we were like, hey, you know what? People should have access to good care, and it should be for free. So, like, let’s go and really see if we can get this thing out of the station. And we did.

Wow. So when you say most people didn't accept insurance, I'm curious, how did you? How did you work that angle that you were able to offer something that was unusual back then?

Vanessa Rissetto: Yeah, I mean, you know, my first jobs were sales jobs, and so I knew, and I have a master’s in marketing, and so I knew a fair amount about business, and I was like, well, what is the barrier to something that is seemingly a luxury item? Well, it’s the cost. And when something changes in your financial situation, what’s the first thing that you get rid of? Something that you think is luxurious? And so let’s remove that, right? But you’ll go. People go to their therapist every single week in perpetuity, sometimes twice a week, because insurance is paying. So it’s like, let’s do this. And at the time, dietitians weren’t getting on insurance panels, so there was a lot of room and a lot of leverage. So the rates that we have that are contracted, that are evergreen are about 25% higher than anyone who is trying to get on insurance panels right now. And also for quite some time, for like two years, insurance panels were closed because COVID happened. People weren’t paying cash. So all of those dietitians that were doing cash found themselves in a bit of trouble. So it was just like, you know, smart business practice.

Liz Reitman: Wow, I love that. So you’re able to bring together, I didn’t realize, a marketing degree as well as sales experience. That’s amazing. It’s clear you guys have had just this remarkable success. And I’m wondering specifically, about raising capital.

Do you have any strategies or any thoughts on how you were able to do this? Especially we all know female startup founders. What we get is such a less percentage of those dollars out there.

Vanessa Rissetto: Yeah. Female founders get 2% of vc dollars. Black female founders get even less. Less than 100 black women have ever raised over a million dollars in venture capital. I am one of them is kind of like cool and sad. It’s like really, it’s really kind of crazy. I always say this all the time. I’m like, EO (Entrepreneurial Organization), just make me come and talk to people about venture and how to do it because I will tell you the things that no one tells you because you think it’s this like glamorous thing and it’s not. Somebody has to level set you. It’s not a personal attack. If nobody, if people aren’t investing in your business, it doesn’t mean that your business isn’t good. It is very difficult for a fund to put dollars behind. People imagine they probably see 2500 to 5000 businesses a year, if it’s a bigger fund. They’re doing only like four to ten deals. So your deal, they’re always going to say no. You got to do something to make them say yes. The first time I ever heard that, I was like, okay, great. And then everyone’s pattern matching, right? Like, think about it. Adam Neumann pissed away a lot of money. Marc Andreessen just wrote him a check for $350 million for that. There’s still nothing yet to materialize. We’re all waiting with bated breath, right? And that’s super frustrating when you know you have a business that works – that’s better for humanity, et cetera. So I think the things here are like, you don’t need to worry about the people that say no. Just worry about the people that say yes. Somebody believes in you. You know your business better than anyone else. I actually got, like, pretty tough with investors yesterday because they were just, like, going in on me about our term sheet. And I was like, hey, you know what? This fundraising environment is really bad. I’ve raised capital multiple times, and I’m very. I’m really unbothered. This was actually, like, pretty soul crushing. And, like, are you on my team or are you not on my team? This business is good. This business runs. This business makes money, and we need to get this business capitalized. And so if someone is writing a term sheet and these terms are not that egregious, we’re going to have to do it. And so, like, I just think that if you are going to raise capital, you don’t need to be afraid or defer to the venture capitalists. They just have money. And that’s very useful. You need it, but it’s not the end all, be all. And so I think when you are reminded of that, then you’re really discerning about who you want to be on your cap table and who you want help from.

Liz Reitman: I love that. I mean, it’s really like, you know your business best, and you really have to believe in yourself, and that’s right. And it almost feels like being an actor. My husband was an actor and saw a ton of rejection. We’d see a commercial that he auditioned for, and he was a tall, white male, and it would be a short, chubby black man. And I’m like, of course you didn’t get it.

Vanessa Rissetto: Yeah, yeah.

Liz Reitman: Just hold true and plow through and get to the right people. I love your positivity, that helps. My business partner, Casie and I, listen to you and seeing what you’re able to overcome is amazing, especially based on the statistics of females and then black females. It’s beyond jaw dropping.

Vanessa Rissetto: Yeah, it’s kind of sad.

Liz Reitman: It is. So one thing I’ve noticed …tell me if I’m correct, you have an all female leadership team.

Vanessa Rissetto: We do have an all female leadership team. That is not by design. It’s just happenstance. However, I did go to an all girls high school. And so I have an affinity towards putting women first. I’m very like, tell the truth. Tell your friend that you hate your husband all the time and you need help or tell people that you’re struggling. Tell the truth. My best friend of 30 years, Robin, I always talk about her any chance I can publicly because she is always on my team, and she has never, ever in the 30 plus years that I’ve known her, let me down. And I just think that is really what’s important, right? So, tell the truth. Let people know. That’s how you’re gonna get help. That’s how you’re gonna move forward. But having this leadership team, I think it’s like, you know, I got cancer last year, and I had to work and act and pretend like everything was okay, and I need people behind me that weren’t out to get me, people behind me that understood the assignment and were like, we are going to help you. And it was like, hey, we’re going to give you full visibility. We’ve anticipated every single question someone’s going to ask. Here are the questions. Here are the answers. You need to memorize them. Let’s go. And so that’s how I got through this past year with that leadership team, so I’m very lucky to have them.

That's beautiful. So, how did you juggle? You know, the balance of being a CEO and a sought after speaker. You've got all this national recognition and media coverage, but now let me add in family and your health. How the heck do you balance all of that?

Vanessa Rissetto: So sometimes I go to therapy twice a week. I’ll be like, I’m doing really great. And then my therapist is like, I invite you to come back another day this week. I’m like, oh, not so great.

Liz Reitman: Talk about being honest, right? Yeah.

Vanessa Rissetto: Yeah. It’s like, okay, I. I have a lot of people who show up for me, my partner shows up for me. We kind of got ourselves back together. And I was like, oh, hey, I have cancer. And he was like, great. I’m doubling down, and I’m gonna be there. And for the first time in my life, I asked people for help. I said that I was struggling, and it worked. Also, my nanny is the most important person in my life. She said to me one time, “I see how hard you work, so I’m gonna work just as hard so that we can get to the end of this.” She’s been with us since my son was six months old. I’m always like, T the first purchase I maKe is a house for you. She says, whatever, I love you so much. So surrounding yourself with people that you can tell the truth to is what is going to take you pretty far.

Liz Reitman: You know, it’s interesting , but it’s really hard for a lot of people to ask for help, maybe, I don’t know if it’s female or if it’s entrepreneur, but, or maybe it’s being codependent, whatever it is. But, you put your head down, you work really hard, and for some reason, that’s really looked at or has been looked at as a sign of weakness.

Vanessa Rissetto: Yeah, I think, we’re around the same age. I think it’s  how were raised, right? Our parents generation is like, do not talk. Everything is fine. Do not cry. Don’t tell people what’s going on with you, because if you tell them, they’re going to use it against you. This parries through your life, and you’re like, oh, okay. And then, yeah, I’m an entrepreneur, but I’m really struggling. You stuff it down, stuff it down. But all that happens, that it comes out sideways, so it’s not worth it.

Liz Reitman: I always say. It leaks out of you. I’ve heard that term from Dr. Brad Reedyand I believe that. Well, how’s your health now?

Vanessa Rissetto: It’s great. I’m cancer free. I did my last chemo April 11. I am living a presumably uncomplicated long life where I will terrorize my children and that’ll be that.

Liz Reitman: And others.

Vanessa Rissetto: And others. Yeah.

Liz Reitman: Well, that’s great. I’m really happy to hear that.

One of the things I was curious about is I see how you're trying to close the gap to serve underrepresented groups. Do you have any specific things that you're most proud of or how you've been able to accomplish that or how you're addressing health disparities in this space?

Vanessa Rissetto: Yeah, I think, like when I am asked to speak, when we’re talking on platforms, I make sure to bring that to the forefront. Right? Everybody fancies themselves knowledgeable about things. Meanwhile, they’re not really. The other day, some entrepreneur asks, why can’t AI do it? And I was like, well, all the data sets are only on white males and that’s not reflective of the general population. You are excluding race, gender. So how can AI do anything, that’s not a good data set. So, no, a bot can’t do it. AI is not the eternal answer, right? And he was just like, oh, okay. So I think it’s that when you are a thought leader, when you know the business, right, like, it’s your job and your duty to go out there and speak and tell the truth, right. Don’t say the things that you think people want to hear, tell the things that you think are really going to help and move the needle. And so I just make sure to lead with kindness, but, you know, there are a lot of disparities out there, and people deserve access. People shouldn’t be shamed because they don’t have as much as the other person or they choose to spend their money in a different way because that’s what’s most important to them. You need to meet people where they are. I think being a dietitian by trade and wanting to help people is who I am at my core, I think, is why I am focused on access and democratizing access to things like nutrition, better outcomes, et cetera.

So tell me a little bit about the success of the business, a little bit more about your organization.

Vanessa Rissetto: Yeah, it’s really cool. In 21, we did $700,000 about right? If you add it up that way, in 22, we did $1.7. In 23, we did $3 million. We are at $5.5 million. We say that we’re going to do six and a half million this year, but we’ll do more than that. We had 4200 sessions last month. A quarter of those came from One Medical. We have 900 active referring physicians. We are doing it. And that I’m really proud. We’ve got 80 dietitians working for us. They’re all W2 employees. We standardize care. We’re supporting them. We’re paying for their licensing. We’re just helping elevate them as a profession. And so that feels really good, but it’s  crazy. I’m like, well, how many work here? 110!

Liz Reitman: I love it. This always excites me because it’s so hard to get to that next level. You know, I’ve run now two businesses, and I see it’s very easy to stay steady. The fact that you’re seeing this tremendous growth, you’re killing it. You guys have figured it out. I’m a member of One Medical, so, yeah, they’re the best. I always feel like any reference I get are amazing. So I have a lot of trust in that organization.

Vanessa Rissetto: Yeah. We’re meeting with their Chief Network Officer, actually, next week to try to paper a deal with them, which is, really exciting. I think, honestly, Liz, the reason that it’s grown this way is because we’re just focused. We’re focused on patient care. Slow and steady, nothing flashy. Don’t spend money on things that don’t matter. And we just want to do good work. And I think if you stick to that, you’re not easily distracted. And you can get there and also, run your own race. Run your own race. It’s okay. You don’t need to make $100 million from your business. Your business can be good and profitable and something that you can be really proud of, and it doesn’t. You don’t need to, you know, $20 million in revenue. $3 million in revenue is a lot of money. You’re a sole proprietor, and you had $250,000 worth of profit last month. That’s great. These businesses that are over here, they’re like, oh, it’s a double unicorn. It’s like, okay, have they ever made that money? Have they ever made $2 billion? It’s a thing. People don’t understand the words, so they’re just like, oh, $2 billion. They’re worth $2 billion. Right. But they haven’t made that money.

Liz Reitman: Right.

Vanessa Rissetto: So it’s okay.

Liz Reitman: I work with in EO, and we have something called EO Accelerator. That’s for people that are under a million, that we try to help them get to a million. But so many times I’m ask, why the million dollar mark? What is that? It’s just silly. If you are enjoying what you’re doing, you’re bringing value, you’re pushing yourself…it’s okay that you’re not over a million. And then you look at how long Amazon took to turn a profit. I think Uber, they said, just started becoming profitable.

Vanessa Rissetto: No, no. Uber will never be profitable. It’s not profitable. It’s so ridiculous. So, yes, to your point, what’s the million dollars do you pay yourself? You have multiple employees. You give them 401k benefits. Do you give them health benefits? Do they get vacation? Yeah, a million dollars is cool because I guess you could say it, but that’s not a million dollars in your bank account because you’re paying payroll to people.

Liz Reitman: And then I hear these individuals that brag about how many employees they have, and I’m like, okay, but, what’s your profit margin? How much are you taking out? I don’t care that you say you have 40 employees. That’s not anything to me. And, in fact, that sounds very stressful at times.

Vanessa Rissetto: It is stressful. Let me tell you something. I have never been happier. Like, sorry, guys. I have never been happier than when I worked by myself or, when I was at Mount Sinai and I was just a cog in a wheel, and I had to see my patients, and I only interacted with my doctors, and I saw my patients, and I went home, and I didn’t have to worry about hurding the cats. That was great. That was awesome. You’ve got 100 employees. You got to make sure all those people are happy, because those people are the backbone of your company. And if they don’t do the work, the business doesn’t run. That is a different kind of job, and you’re the leader. So when all this stuff is breaking, it’s on your back. You’re the one that has to take the hit first. Not for the faint of heart, guys.

Liz Reitman: No, not at all. I’m always impressed with, like, the EO members that have businesses with no employees, yet they’re made, like, $5 million. I’m like, wait, how did you do that?

Vanessa Rissetto: 90% gross margin. Let me talk to them.

Exactly. So what do you think is, maybe one of your biggest learnings from building this business?

Vanessa Rissetto: I have learned that I am pretty resilient as a human being. I’ve also learned, actually, what I have interest in. I think this was just the stepping stone for the next thing. And I think the most meaningful work is, first of all, I’m an operator, and I know how to operate a very good business, so I can then get in the s**t with somebody and help them operate their business if they want that. So I would like to do that. Anybody wants to call me, I will. I’m happy to help you. Give me a call. I am also interested in raising a fund and deploying capital. A baby fund for a larger fund and give them deal flow and be like, this is a good. This is a good one. This is. This one. Maybe not, or whatever. I think that would be very fun to give money to people who are different, but, you know, no one’s taking a chance on them. Take a chance on somebody that people otherwise would not.

Liz Reitman: I love that. I mean, talk about becoming a dietitian to creating your own fund. What the heck?!

Vanessa Rissetto: Yeah, it’s a surreal circle. I don’t know, it’s like, whoa, did you need to do this in order to do that? But I think so. I think, you know, you had to operate a business, something really hard, something that no one had ever done before. So you could say, like, oh, yeah, actually, I know what I’m doing. I’m not afraid. And I can help you.

Liz Reitman: That’s really cool. I love that.

At Culina Health, we believe that everyone deserves affordable, quality nutrition care from a credentialed expert. We pair patients with registered dietitians for personalized, one-on-one virtual nutrition care that is science-based, inclusive, and culturally affirming. We offer non-judgmental, sustainable, and multilingual support in all specialities, and we honor all patient backgrounds.