Sarah Romoslawski
Mixed Methods UX Research and Leadership

Virta Patient Health Journeys

Building a cross-disciplinary empathy practice

Health Journeys at Virta

Logging biomarkers in the Virta mobile app

What is Virta? 

Virta allows patients with Type 2 Diabetes to reverse their chronic illness through dietary changes, health coaching, and continuous remote care.   

User Listening Fortnightly
Health Journeys Monthly

User Listening Fortnightly

When I first started at Virta I was asked to take over a meeting that had an unclear focus.

Feedback channels:

  • sustainability survey

  • mobile app satisfaction survey

  • rolling NPS

  • ad hoc NPS

  • health coach satisfaction

Focus of meeting:

  • customer service meeting

  • create call assignments for negative feedback coming in through the above channels

Cross-Disciplinary Involvement

  • Product Managers

  • VP Product

  • VP Operations

  • VP UX

  • Operations Manager (Manager of all the Coach Managers)

  • Data Science

  • Designers on the patient side

  • Lead Coach

Saw an opportunity to build cognitive empathy:

  • Rather than call patients and start solutioning with them, I suggested we conduct 45-minute listening call following Practical Empathy methodologies

  • The meeting could turn into a place for us to share what we hear and capture patterns along the way

To build cognitive empathy we must uncover the following:

  • inner reasoning

  • reactions 

  • guiding principles 

  • philosophies

  • common ability blockers

  • past experiences and how those shape their current values

  • the inner thoughts of someone trying to adhere to something antithetical to what we have learned as healthy all our lives


  • conduct the listening work

  • share individual stories across the company

  • create thinking style segments 

  • form a mental model diagram and an opportunity map 

Health Journeys at Virta

Canal Barge patient screenshotted from Virta website

A Note On Problem Space Work

The Jobs to be Done Playbook (Jim Kalbach)
Practical Empathy (Indi Young)

Virta patients came from many different backgrounds.  Most were offered Virta as an employee benefit. We were lucky to be able to recruit many different people:

  • Barge operators

  • Truck drivers

  • Casino workers

  • Tribal nations

  • Tech workers 

  • Retirees

  • Veterans

  • Direct patients - the only patients paying out of pocket

1. VHA

2. Direct Patients

3. Patients that Did Not Apply

Veterans Health Administration

Our goal was to understand the needs of Veterans that had stopped logging biomarkers and/or delayed dietary change start date.  While this behavior was seen across the patient base, this group over-indexed on these two issues.

What has been going through your mind since you signed up for the Virta treatment?

What has been going through your mind since you stopped logging?

Health Journeys at Virta

Example note-taking sheet. These notes were from a patient who delayed dietary change start date.

Templates and Training for Listening Calls So All Disciplines Can Get Involved

  • Templates created for email contact, calendar updates, script

  • Note-taking template helped team members capture thoughts at end of the session 

  • Reflect on calls after completed to share patterns and improve listening practice

Findings from VA Patients

Inner Reasoning

Needed help from friend in order to wrap my mind around it before setting a start date


Feel frustrated due to lack of clarity on the treatment 

Guiding Principle

Always get second opinions (e.g. from family, friends or VA community)


Gained support across the organization for VHA patient community group

Improved enrollment advisor communication and messaging when communicating with VA patients

Direct Patients

Direct patients are both customers and patients.  They are the buyer and the user.   They are our hardest customers and our largest potential for revenue. - VP Operations


  • Direct patients pay out of pocket ($250)

  • Health Coaches wanted to better understand how to serve their toughest patients


  • myself

  • 3 health coaches

Inaugural Health Journeys Monthly

  • Each team member shared on 1-2 patients including verbatim audio clips

  • No health coach conducted listening sessions with their own patients

  • This was the first "patient voice" that was not entirely focused on positivity and life changes

Health Journeys at Virta

"Who wants to drink an avocado smoothie?"

We Brought Insights Beyond Outcomes

Inner Reasoning

Thinking that the food available to me to eat was not appetizing at all

Knowing that I can't stick with it unless I have someone cheering me on


Felt frustrated when my provider told me to change to a different medication level without explaining why

Felt annoyed when I had to wait 24 hours for a response

Guiding Principle

Organic first

Be a daredevil


Do better to build trust by learning how to capture those moments asynchronously

Health Journeys at Virta

Worksheet for brainstorming connection and trust along the patient journey

Painting a View of Trust 

Wanting to know more about how trust is built over time, we kicked off a learning plan for understanding the patient and provider trust relationships.  

We included:

  • Direct patients

  • T2D on medication

  • T2D no medication

Looking Beyond the Current Patient

The next Health Journeys Monthly focus was planned for understanding those who never applied. Despite having access to Virta for free, they did not enroll.

Health Journeys at Virta

Continuous Glucose Monitor (CGM)

Uncovering Finger Pricking Fears During Enrollment

Discussion with the EA:

  • What happens when someone has a fear of finger pricking?  

  • How do you end up finding out?

  • What do you do?  

  • Do you ask why?  

Did you know some of our patients are using CGMs anyway and they love it?

Impact on service touchpoint: Adjust to putting a positive spin on CGMs, ask about reasons for fears on enrollment call to address anything that may not be true

Listening Sessions
Health Journeys Monthly

Future Listening Work in the Health and Wellness Space

What went through your mind...

...the last time you tried to get help for chronic pain?

...the last time you tried to change a behavior?  

...the last time you considered a medical option to treat a health condition?

... the last time you considered a new health benefit for your employees?