By Shree Nadkarni
The podcast currently has 82 episodes available.
Welcome back to Common Sense Medicine! This is a great interview with a physician who is working in the intersection of the care navigation space. Patient-centered care can mean a lot of things to a lot of people. For me, it means that patients are heard in their care journeys and feel as though they have agency in a system which is often confusing and not at all “human-centered.” My guest today is trying to change that through providing a better solution care navigation in cancer care.
Dr. Hillary Lin is a Stanford-trained, board-certified internal medicine physician and the Co-founder and CEO of Curio, a HealthTech startup addressing health equity and outcomes via Al-enabled navigation.
Dr. Lin has contributed to neuroscience and oncology with her peer-reviewed research work. She is a frequent speaker and advisor for programs, including Headstream Innovation and Cornell BioVenture eLab. In her personal life, she enjoys immersive experiences and has completed over 200 escape rooms worldwide.
Video Version
[00:59] Hillary’s background in medicine, and Curio’s start
* She entered medicine because she was passionate about the “human experience,” she knows how complicated life can be and how important health is
* It’s about all of the aspects around health that you also have to manage when you are sick and not just the disease itself
* There’s too much focus on the facts of medicine and the facts of biology and it sucked out the “soul” of medicine for her
* We’re asked as physicians to remember more facts and be computers rather than a person to help guide the journey (AI can help here)
* Drove her to specialize in oncology because she wanted to be deep in the process of answering existential questions, but when she got there she found out it’s mostly running in and out of bedrooms and clinic rooms. She was trained in internal medicine at Stanford and then went to Columbia for a brief time in an Oncology fellow role
* You don’t get time to sit down with the patient that much
* She found that she wasn’t answering the existential questions she wanted to, so she went to digital health innovation and sampled the smorgasbord of what she could be doing, and finally she landed on cancer care navigation
[06:16] What is so compelling about care navigation for patients?
* Took her a long time, she was seeking for years to land in a field to innovate in
* In the beginning, as a relatively new founder, like many founders, she went straight to where the problem was—when founders do this, they try and create a tech-enabled clinical platform for whatever they want to solve quickly. She thinks this is the first-order solution, rather than the final state
* They found that with more serious healthcare concerns, a lot of it comes down to navigation problems / concerns. Health literacy, access, and equity are prevalent in the U.S. where we have a convoluted system. It’s very hard for them to get optimal treatment and care
[08:44] All about Curio—what is it & how does it help their end customers?
* Problem they’re solving: Help patients get the resources they need in order to optimize their health
* The tooling behind that (which is growing) is vast, and it’s growing in real time Shree’s note: the tooling now may be different then when we recorded this podcast in November 2023
* One example of a tool is a natural language parsing tool to provide the opportunity to explain a problem and can connect to a in-person navigator to find those services, or use the AI to find them a personalized service which can help them find the solution for their specific issue
* The next level of that is to guide them through the steps to get the resources that they need. Instead of having a case manager or a social worker on the line, they can use the AI to navigate the next level
* The key thing to understand is a B2B company which works with health delivery platforms, non-profits, patient support services, and similar entities. 80-90% of the time, there is a human in the loop, such as a social worker or another personnel
* Rather than focusing on just a patient assistance program in a specific zip code, you can use Curio to add additional parameters (i.e., age, family members, etc.) to add greater “precision level resourcing” for cancer patients
* There’s also a level of communicative support which uses generative AI to help individualize to the patient’s health literacy level in an SMS or email communication
[14:35] What are patients most using Curio for?
* Financial assistance is by far the largest problem which patients face with a cancer diagnosis, and financial toxicity is the main focus of Biden’s Cancer X initiative
* It takes up to 80% of people’s bandwidth and mindshare. Cancer care is so incredibly expensive that people max out their deductible pretty quickly. There’s also legal type of concerns especially with their employers (i.e., leaves of absences)
* In an earlier rendition, Curio was a mental healthcare company. They found that for cancer care, mental health is a secondary concern, after people are able to pay for their medications and their base needs. There are a lot more resources to tackle mental health than other issues though
[18:12] Curio’s business model
* They sell to intermediaries, navigation and utilization discovery services. The ecosystem has become very bloated with point solutions for digital health that benefits administrators get burned out
* Shree’s take: Curio is really trying to differentiate their navigation solution based on its personalization through partnerships. For example, if you have a MSK issue, Curio will basically tell you which piece of education you need to read for your particular issue
* They use both human / automated version of finding those resources, but they prefer a partnership because then it is more intricately tied to the experience of navigating care
* They use a tiered utilization pricing model for Curio’s care navigation solutions. They align well for utilization based pricing model because sometimes there’s very low utilization of those benefits
[27:16] What do oncologists think about this tool?
* Trust is key to get buy-in from various providers. They are trying to establish strong relations with patient advocacy groups—this is not to just have their logo on their website, but to have relationships with them
* Hospitals don’t reimburse for care navigation services, so it’s pretty awesome to see that patients are getting these services outside the hospital. Doctors don’t get paid (RVUs) based on them helping the patient navigate the system; social workers are strapped for their time. If patients find Curio or another tool, it can be a real game changer for them
* They are also working on the pharma side where they are focused on getting patients more adherent onto their treatment, and focusing on patient engagement. Pharma companies want to know why patients aren’t continuing on their treatment (i.e., copay, adverse events, etc.) so it’s actually pretty helpful for them to understand where in the patient journey they are losing the consumer
[32:49] Does Curio help with finding second opinions?
* They work with advocacy groups to help find second opinions for their patients. In fact, in Hillary’s opinion, a lot of doctors do value second opinions and look to get them from academic institutions (i.e., you have one oncologist at an academic institution and one in a community setting)
* They are working on getting a database for clinical trials so patients can use that to find trials which are very helpful to them. Patients are very skeptical of trials, so according to her, getting patients there is 90% of the issue
* A lot of the convincing happens at the education level and the risks and benefits of the trial
[40:16] What is different about Curio?
* Shree’s note: I read an market map of the Generative AI in healthcare space, where they talked about how the care navigation space is becoming crowded—so I asked Hillary about her opinions in the care navigation niche
Navigation companies, such as Navvi Health, Collective Health, Auxa, and Talktomira, focus on helping employees and patients navigate their healthcare benefits and options. However, these companies face challenges like overcoming vendor fatigue and budget constraints in the current economic climate. Interestingly, these companies have the largest amount of funding in this category and the lowest amount of median funding per company, which implies the category is more saturated and less capital intensive then other patient-facing categories. We’re excited to see how generative AI can streamline user experiences, interpret health information, and guide patients more holistically, potentially reducing readmissions and encouraging proactive care.
* Curio is good at patient engagement, which a lot of digital health companies have not been successful at (according to Hillary)
* Each product / feature release has to be laser-focused on that particular use case—they are trying to solve problems with technology rather than with humans
* A lot of care navigation companies are human first, with technology enablement, where she thinks it has to be reversed—tech first, with human enablement at points, so that it can scale
* Now with generative AI, this scalable solution is now possible
[45:48] What is the future of Curio?
* They are trying to provide a broader layer of tech for the vision of healthcare—a human person is more than their disease, so they have to have a broad way to access that care
* Rather than becoming verticalized, they want to go more horizontal—focus on nutrition, wellness, or other places
[47:04] Why go into Digital Health?
* It took her years to get her legs underneath her as an entrepreneur. She believes we’re living in a world where healthcare is stuck in an outdated mode of manual labor
* Looking very closely at other industries, all other industries are moving towards this idea of personalization, but why can’t we focus that on scaling up healthcare for a lot more people?
Welcome back to Common Sense Medicine! This is the last post of the year, moving into the holidays, so wishing you happy holidays and a happy new year.
In this episode, I’m joined by Stuart Blitz, who is the Co-Founder and Chief Operating Officer at Hone Health, a men's optimization clinic that offers at-home blood tests, tele-health consultations, and medication delivery.
Prior to this, Stuart held the position of Chief Business Officer at Seventh Sense Biosystems (now YourBioHealth), where they played a key role in designing and developing the world's first push-button blood collection device. Before that, they worked at AgaMatrix, where they served as the Executive Director of Business Development and Strategy, as well as the Director of Worldwide Commercial Development.
Stuart's experience spans over several years and includes a focus on improving healthcare systems and providing convenient solutions for consumers.
Check out the episode on Spotify, iTunes, or YouTube
If you’ve been forwarded this email and are just getting this for the first time— thanks for reading! I publish podcasts monthly and I’d love for you to subscribe using the link below.
Video Version
[1:00] Stuart’s origin in HealthTech, and how he created the first-ever medical device for the original iPhone
* Started his career and joined two founders who started AgaMatrix in the diabetes space
* He had done Biomedical Engineering in college at Johns Hopkins, and he was sort of the “black sheep” there because people didn’t want to go to health startups in 2002, but rather medical school or government or research
* AgaMatrix made glucometers with test strips for diabetes and then launched a medical device company
* They ended up getting to retail pharmacies, and 15 years later the device that they made is still on the shelves at CVS, Krogers, etc.
* They started working with Apple in 2007, right around the release of the first iPhone, to create a smart glucometer which was cleared by the FDA
* They were able to partner with Sanofi, and distributed their product in 20-30 countries
[4:22] Why he decided to stay at AgaMatrix for 10+ years
* Every 2-3 years, he did something new, so it didn’t feel like that long
* The first couple years were core startup mode to figure out product-market fit and raise capital.
* The first idea was to make software to make glucometers work better. This was a stupid idea because people make money on the glucose test strips and not the glucometer themselves
* The next few years were about growing and selling, and they signed a bunch of deals to distribute their products. One was Liberty Medical, which provided products to people on Medicaid
* The last few years were about distribution, building around new partnerships like the international one with Sanofi and scaling their sales team to get into more patients’ daily routines
[7:07] How did he pivot to SeventhSense Bio?
* He had a lot of experience in HealthTech and diagnostics, and had met SeventhSense Bio before joining them
* They had an interesting angle on at-home testing, which would require an easy device to get that blood from the patient without the assistance of a healthcare professional
* Met many founders (ex. Hims, Romans, and also the much-maligned Theranos) and saw the D2C angle for medications
* Key insight was they haven’t gotten to mass adoption because of cost angle, usability angle, and lab compatibility angle
* Most important is the usability angle, because at-home diagnostic has to function 99% of the time, the first time (there are no “re-dos” because it isn’t like the patient has another tube or a professional to help them at home). The devices that are on the market right now aren’t there yet, but might get there
* His thesis was that there are going to be way more D2C, cash-pay, access companies started but they’re going to get started around high-niche customers who aren’t getting serviced already by the system
[11:39] Founding Hone Health
* He met his current co-founder, Saad, and liked his story. Saad had turned 35 and he had all the symptoms of Low Testosterone (Low T)
* Saad approached Stuart in his role at SeventhSense Bio and thought that his at-home device could help measure low T in his customers
* Stuart said it might not work that way, but he was intrigued by the business model and decided to join Saad at Hone Health 4 years ago
[13:23] What does he think was core to build Hone?
* Shree’s take: With D2C companies, I see three issues — the patient needs to know that they have the disease, they need to know where to go to treat it, and they need to make sure that the provider also knows how to treat this under-serviced condition
* Something that was core to the offering that they built was through building their physician network. A lot of HealthTech companies would use Wheel or SteadyMD provider networks to get started, but the specialty care that Hone provides prevented them from doing this
* Stuart can tell if the physician is knowledgable about treatment for male hormonal health in 1 minute — do they (1) know the patient population, (2) do they know the protocols around dosing testosterone, (3) are they committed to the clinic by responding frequently / giving this the seriousness that it deserves, (4) can you use technology well to treat patients, and (5) do they pass the vibe check. Below is a video of his real time reaction when a doctor says they don’t know the correct dosing of testosterone
* Hone’s business model is that a physician meets with a patient after they get labs via a tele-medicine consult, and then they determine based on AUA guidelines whether a patient needs to get low T. Then, the patient gets on a subscription plan to pay for the treatment and has a consult every 90 days
[21:54] Risks to Hone’s business model by using telemedicine with controlled substances
* Context: The Ryan Haight law prevents providers from using telehealth from prescribing controlled substances. It was temporarily waived during the pandemic, when people needed them to continue on treatment (think Suboxone for opioid dependance, or Testosterone like in this case)
* Stuart doesn’t think it will be a big risk because the law originally was meant to prevent people from googling “Vicodin” to buy it online. This law came out 15 years ago when telemedicine was far from prevalent
* The DEA had a proposal (summarized by Stuart) that said that a patient should see a provider in person at least once in 90 days to continue on that prescription for the controlled substance. Hone’s patient population would be OK seeing a practitioner, Stuart thinks, because they go to LabCorp every 90 days for a lab test to continue being on Testosterone
* The DEA held sessions in September 2023 to learn more about what to do about this restriction, and they decided to make a special registration process to make sure that providers could be able to continue to prescribe controlled substances via a telemedicine pathway which (he thinks) will be finished by the end of next year (2024)
[27:11] Surprising things that Stuart learned about the patient population at Hone
* Patients want options, it’s not about either getting labs taken at-home or in the clinic, but it’s the option of getting it at one or the other. You could have a patient in a city who has LabCorp 10 minutes away from them, or a rural area where they have one 150 miles away
[29:01] Hone Health’s Unit Economics
* Stuart thinks that Unit Economics have to work from day one, and that VC-backed companies cannot stay afloat if this basic tenet is not met because simply relying on growth will not outpace profitability
* They want to expand to longevity, thyroid care, obesity, etc. Right now, they don’t serve that and their providers will send them elsewhere to get that care
[31:20] Stuart’s hot takes on Twitter
* Stuart thinks that there are many players in the space who are making money off of the “bad things” that are happening in healthcare. If you insert X thing here, and you ask “why isn’t anyone disrupting this? It’s terrible for patients,” there’s probably someone profiting off of that
* Hone Health might have some competition as more clinics pop up, and there is a “race to the bottom” as they compete on pricing, but they can compete on the value that they provide to the consumer
* One of the key learnings that they had on Hone Health was that in order to keep OpEx low, they have to be scrappy. Stuart mentioned if you’re starting out, just “use Google Sheets.” Then you can figure out how to get your first customers, and then build from there
* Those learnings are very critical and they can serve the business
[38:53] Building their own HIPAA compliant EMR
* They are not serving a population which requires Meaningful Use metrics (i.e., Medicare), since they are out-of-pocket / cash pay for all of their costs, but if they were then they will add on compliance after the fact
* They first got one off-the-shelf, but it was pretty bad and wasn’t helpful. The off-the-shelf EMR was fine for doctors who were writing notes, but the problems came in from a product standpoint, where there weren’t meaningful ways to onboard patients and have a good patient journey
* This was complemented because each of the founders had their own expertise, so they were able to build a better company by having a lot of synergies (marketing, finance, ops, marketing, brand, etc.)
[43:48] Stuart’s vision for the future of Hone Health
* At a minimum, they want to be able to network with payers. They want to reduce out-of-pocket costs for patients, and they want to expand the amount of benefits which they can tackle using Hone (i.e., longevity, etc.)
Welcome back to Common Sense Medicine!
In this episode, we're joined by Dr. Jimmy Turner, an academic anesthesiologist, self-proclaimed money nerd, and host of "Money Meets Medicine" podcast. He's also the author of "The Physician Philosopher's Guide to Personal Finance"
Dr. Turner's mission is to empower doctors to find work-life balance and financial freedom. We delve into his journey from burnout to empowerment and discuss his involvement with Attend, a groundbreaking startup that redefines how physicians navigate financial challenges. For more insightful discussions, be sure to follow him on Twitter (@TPP_MD) and check out his book, and visit Attend's website for valuable resources and support.
Join me as I explore the intersection of medicine and finance and discover practical solutions for physicians seeking a better quality of life.
Again, if you’ve been forwarded this email and are just getting this for the first time— thanks for reading! I publish podcasts monthly and I’d love for you to subscribe using the link below.
Video version
[0:00] Introduction
[0:34] Jimmy’s story and learning more about the startup world
* He did anesthesiology residency and fellowship at Wake Forest, and stayed on faculty there
* Really started getting involved in learning about how to manage his money during fellowship — read the blogs, the books, and dove deep into the podcasts around personal finance
* He really liked teaching others and he stayed in academic medicine and students, residents, and fellows used to ask his tips about money management
* He married burnout with financial wellness, and his first business, The Physician’s Philosopher (TPP) was around combating this idea about financial wellness
* There is an intrinsic link between financial wellness and specialty choice / when you start a family / how you practice
* He started a couple of podcasts, wrote a book, and became a top 5 name for physician blogger with TPP
* That led to him starting a business with his co-host for Money Meets Medicine podcast, Dr. Lisha Taylor
* Attend’s north star - “Legitimately do what’s good for doctors using technology”
* Jimmy’s mission is trying to put people over profit, and Attend’s mission of being the comprehensive solution which is best for doctor’s financial wellness was too good to pass up and was highly appealing to him
[5:00] How do financial incentives impact physicians?
* Jimmy would get told not to make a formal curriculum for students and residents around personal finance, both of which he does now
* Nobody wanted to talk about money because they didn’t want to cause any trouble
* In fact, higher student loan burdens are linked with lower in-training exam scores. In-training exams in an internal medicine cohort (n = 16,394) showed that scores decreased as educational debt increased, with a mean difference of 5 points (IM-ITEs are scored as a percentage of total questions answered, only 260 out of the 300 items are scored).
* This suggested to Jimmy that as a residency program, they should be ethically bound to teach their residents the ins and outs of personal finance wellness
* Conflicts of interests are important to consider, but physicians already have conflicts when they have relationships with device manufacturers
[07:15] Jimmy’s experience with entrepreneurship and lessons learned
* There are 2 schools of thought around entrepreneurship — (1) hustle as hard as you can or (2) take some time for yourself and make sure you can have a sustainable life outside of your business
* He started out on the first camp, and now he’s squarely on the second. He first started out with 60 hours / week with his main job as an anesthesiologist, and 20 hours / week on the business. It transitioned to more hours in the busines and less hours in anesthesiology until he arrived at his current split of 2 days / week as an anesthesiologist and the rest is on the business.
* By the end of the first year, he hadn’t made any money. By month eighteen, he might have broken even in the $5,000 he put in to make the website
* He realized that in order to help people, he had to make his business grow, which in turn required revenue
* He sold the personal finance business of TPP to Attend, where he became the Chief Medical Officer
Fear is by far and the way the biggest lesson. Doctors are usually afraid of failure, and we haven’t experienced much of it. However, in entrepreneurship, you’re going to have a product, or a service line, which doesn’t bring any profit to you. And you’re going to have to take those learnings and improve.
[11:12] How does Attend make money?
* Attend makes money on consults for student loans / disability insurance. From their website, they can work with you in defining a plan for you post medical school how to manage your loans and how to pick a good disability insurance
* Jimmy said that their consults usually cost around $200-500 per consult, and they are framing it as a way to save hundreds of thousands of dollars in the long term with your student loan burden
* Jimmy mentions that his friend decided to refinance his student loans with a private loan lender, and it cost him $400,000 in student loans because he doesn’t qualify for the public loan forgiveness program (PSLF)
* Shree’s research: I found that their products include $199.00 per student loan consult and can split it up over a few months, and they serve as a point person for good insurance disability quotes. I think that they have some sort of relationship with the brokers that they use for disability insurance, to either get a flat fee paid out to be part of their “trusted broker” list or some other revenue sharing arrangement.
* Jimmy mentions that all of their employees earn a flat salary so they are not incentivized to push any larger policies to earn a larger commission; they are trying to design incentives so they don’t screw people over by preventing them from being eligible for disability insurance
[13:38] Jimmy’s story about disability insurance / his journey to personal finance
* When Jimmy was a fourth-year medical student, he had his first child, and wanted to get life insurance
* He sat with a brother of a friend who was an insurance salesman and bought a private disability insurance policy which was fully underwritten and involved a deep dive into his medical history
* Jimmy takes propranolol for essential tremor and has an ADHD diagnosis which he takes medication for, and this prevented him from getting disability insurance
* Most residency programs have a Guaranteed Standard Issue (GSI) policy which is available to trainees if they haven’t been denied or haven’t been disabled. If you don’t have an income, this none of the rest of personal finance matters
* He thinks that disability insurance is the #1 financial task for physicians in residency because you’ll never be more insurable than you are now
* You have to be able to tell the insurance agent everything, because they can’t go to the medical boards. If they find something in the medical underwriting piece, you’re toast
* Most insurance agents won’t tell you about the GSI plan
* GSI plan is only available during training and three months, usually, out of training. It locks in your rate in training and then, when you’re out of training, allows you to buy more insurance as your income increases
* A fully underwritten policy isn’t bad if you’re healthy, but make sure that you get a benefits rider to make sure your health history is “locked-in” at this current time because most people develop a medical problem during residency
[18:53] What are some financial lessons which residents and students should know as they’re starting their career?
* When you’re graduating medical school, the name of the game is preventing debt
* When you get to residency, get disability insurance and make a student loan plan and see how you’re going to join PSLF. Avoid revolving credit card debt like the plague
* Work on the smaller tasks during residency — make an emergency fund ($1,000 as a resident, 3-6 months of living expenses as an attending physician)
* Doctors are really bad at backcasting, and don’t reverse engineer when they want to retire
* The Diderot Effect, AKA lifestyle creep - obtaining a new possession often creates a spiral of consumption which leads you to acquire more new things. As a result, we end up buying things that our previous selves never needed
* If you have extra money, you will spend that money. You have to know that it is coming as an attending physician
[22:05] Discussion around Roth IRA / 401K and investing
* You would rather pay the taxes and then invest as a Resident in a Roth IRA, and when you’re in your Peak earning years, you put it in a Pre-tax vehicle (401K) (RR, PP)
* The only caveat is that as a trainee, in an income-driven repayment program, your loan payments are based on your post-tax income (Adjusted gross income - discretionary income). If you contribute to a 401K, your student loan payments will be smaller
* If you have a 401K match in residency, then you should definitely use it (“It’s free money!”), but be careful about the vesting period — you don’t want the money that you earned during the match to evaporate if you sign a job offer at a different institution
[26:09] Refinancing student loans — why are doctors so bad at decision making?
* The savings from Attend are often immediate — long term, there is always a return for these consults
* When refinancing, you don’t want to do it with a private lender. Jimmy thinks that every single company should have the disclaimer that “If you refinance your student loans, then you can never do PSLF ever!”
* Every company which recommends a particular lender to refinance with gets a kickback to do so
* PSLF is public service loan forgiveness program, which is a program which lets you get your loans forgiven tax-free.
* In order to qualify for this program, you have to be enrolled in an income-driven repayment program (IDR) administered by the federal government, where loan payments are driven by your income
* The two IDR programs are SAVE (formerly REPAYE) and IBR (income-based repayment). SAVE is a great plan for a majority of people — it allows for a cap on interest for your loans and can exclude your spouse’s income.
* Right now, there are four IDR programs, but they are consolidating into two (SAVE and IBR) in 15 months and you have to be in one of them to get PSLF
* You have to make 120 non-consecutive qualifying payments on a federal loan, have to be in an income-driven repayment program (IDR) and work at least 30 hours a week for a qualifying employer (80% of hospitals are qualified state organization, federal organization, non-profits which allow for this) to get your loans forgiven. Residency payments which are low qualify for this program
[33:10] Non-clinical careers — what do you tell people about making the switch?
* You can still be an entrepreneur in medicine — a private practice doc, etc. Entrepreneurship allows for autonomy and allows Jimmy to control his schedule in a holistic way, more than medicine does
* Also, burnout is a big problem for physicians and people are tired of it
* If you can find a coach who can accelerate your journey for what you want to do, it’s easier to achieve your goals. It is an uphill battle to found your own practice, but lean on people who have done the work before
[40:11] Jimmy reflects on the most valuable advice he was given
* He had a coach walk him through the process of why his business was failing. He wasn’t trained as well to manage a business. The coach mentioned that he didn’t have to do it all by himself
* He was initially worried about the cost of running a business, but bringing more people into the business was helped him to improve the business
* The best process improvement that happened during his business-building experience was the onboarding process for customers and building out the customer relationship management (CRM) system
[43:40] What are the biggest failures that you’ve faced?
* Ryan Holiday’s “Obstacle is the Way” really helped him contextualize the process of failure into a stepping stone rather than a final destination
* You have to experience the failure in order to learn the lesson
* He was scared of offending people, and he had to realize that he was going to offend someone when he picked up a mic or typed something on a keyboard
* Getting over the fear of being perceived as a failure was a big hurdle for him as well, and he was scared of being judged
* Jimmy thinks that sales is a service, and it’s not sleazy. You’re trying to provide them a service which makes that
[47:29] What’s Jimmy’s favorite car?
* It would have to have manual transmission, and it would have to have a lot of horsepower
* There aren’t that many cars left like this: You have the CT4 Blackwing (which he drives), or a CT5, or the M3 / M5 BMWs
[49:23] Which books would you recommend?
* From a business perspective, “Never Split the Difference” by Chris Voss, “Think Again” by Adam Grant, “Leaders eat Last” by Simon Sinek, and “The Hard Thing about Hard Things” by Ben Horowitz
Welcome back to Common Sense Medicine! For the post, skip down ~2 scrolls
Long time, no see, you say. Well, that’s true. I’ve been busy and not-so-busy these past few years, and the long overdue post about “where have you been, Shree?” is coming—I promise. But first, a reflection. Since 2018, when I started this show, the world of healthcare, and my own perspective about it, has changed tremendously. However, there is one constant: talking to people who are “in the weeds” (to borrow a corporate phrase) of the work is the best way to get up to speed in the space.
There is so much happening in the world of healthcare like Generative AI, electronic health records, and biotech, and I want to write more about all of it. As I’m in a more “chill” part of medical school, I’ve been taking the time to talk to founders of interesting HealthTech startups to build a framework about where the industry is headed.
When can I expect more posts?, you say. First of all, I’m not sure anyone is asking for more emails in their mailbox, but I hope that if you’re subscribed, I’m providing some value. I’m not trying to clutter your email—I think there’s a space for interesting conversations about healthcare around 1 time a month. Plus, most people just skim anyway so I’ll try and keep the show notes and insights on the shorter side. Alright, now that I’ve gotten the niceties over with, here are the show notes.
Forwarded this email? Subscribe below for musings about healthcare conversations with people who are much smarter than me.
What is Anja Health?
Anja Health is a health and technology company that provides cord blood, cord tissue, and placenta banking. They are one of the few companies in the world that offer these services. Anja Health's services include:
* Freezing umbilical cord and placenta stem cells
* Sending a kit to soon-to-be parents in preparation for their birth experience
* Safely collecting and storing your baby's stem cells for future cell treatments
* Providing an easy to use collection kit with FDA-approved materials
* Manual lab processing for maximum stem cell volume
* 20 years of secure cryogenic storage at -180°C
* Personal support from a banking or birth expert
Anja Health's mission is to create one more treatment option through the power of stem cells. Anja Health was founded by Kathryn Cross, just over a year after graduating from Wellesley. Kathryn shared her personal story of founding the company in memory of her brother Andrew, who was diagnosed with cerebral palsy after a near-death accident with me on Common Sense Medicine, and below is a summary of our conversation.
Show Notes (with timestamps)
* [00:02:18] Cord blood stem cell space.
* Kathryn talks about a Duke University study which was a randomized, double-blind crossover trial on cerebral palsy (CP) treatment with autologous cord blood (CB). It didn’t show statistically significant results between the study and control groups, but a significant difference was found between the group that received infusions with a higher dose of (>2.5 * 10^7 cells) versus those who did not.
* Providers historically have not been educated about giving information about cord blood banking, and social media is easier to go direct to the customer to educate them about the cord blood banking. She spoke about creator-led businesses, which have greater trust (especially in the beginning) when they have relatability and value capture on their side. This was the enabling factor to gaining and acquiring their first few customers.
* [00:07:45] Lessons from team members.
* She was a younger founder, and she needed to read a lot of material around management to “learn the ropes.” She touches each part of business, but she has been decreasing her involvement with ops to focus on growth and marketing. She tried to find someone who is better than she is at parts of the business, and then aligning with them to achieve the goals which she has for Anja.
* [00:11:19] Fundraising process and mistakes.
* Kathryn talked about using a process to fundraise for a startup using Ryan Breslow’s book Fundraising. He recommends to only fundraise for 3 months, and make sure that you don’t fundraise too early before you have product-market fit because the growth will be very painful if so. Kathryn thought that she fundraised too early, and this was partly because she didn’t have a process going into her fist fundraising round.
* [00:15:17] Private blood banking - why should parents use it?
* Kathryn says that most pregnant people should be using cord blood banking because the placenta and the cord blood bank can act as a sort of “insurance” against a worst case scenario. Physicians can use stem cells to prepare treatment and then Anja Health is able to release a patient’s units to the provider, and then it’s used to give the patient the stem cell treatment.
* Shree’s take: I’m not convinced that doing this by way of a private blood bank vs. a public blood bank is still reasonable in this day and age, because the cost doesn’t justify the evidence which is currently available. If you’re bullish on storing on a private blood bank, look for one which is AABB accredited (by the FDA, like Anja is). The one drawback from a public bank which I had noticed is that you might not get your cells if someone else had already used it, but looking at the Duke University study and others in the space, the blood collected might not be useful if you only have one child to do an autologous stem cell transplant—as most of the research is done in preclinical models. However, that’s part of Anja’s allure, because you might be able to use it in the next 20 years for therapies which haven’t been discovered today.
* [00:24:24] Using placenta stem cells.
* When someone actually donates a blood bank sample, they can increase the density by first sorting it manually. Anja Health mentions that they can do it manually but other companies say that the automatic sorting helps them get rid of contaminants.
* Shree’s take: I think that this is a function of marketing—if Anja Health is able to capture more of the market and convince their buyers that automatic sorting = bad, and that manual sorting = personalized, then they can effectively control the narrative that their method is better. Kathryn also mentions that she doesn’t have any statistics about how many people actually use their stem cells, which gives me pause. How useful could this be if people aren’t using it and it’s mostly a function of marketing? In fact, one paper shows that automatic sorting actually increases the yield of the cord blood separation.
* [00:28:05] Stem cell research in pregnancy.
* She’s excited about more general parts of women’s health related work — infertility and PCOS which came to mind. She also thinks that you shouldn’t consume your placenta, ya nasty.
* [00:29:24] Scaling content and creator burnout.
* It’s really hard to scale content because there’s a threshold to how much content you can produce. She batches a lot of content, but it’s hard to scale them. She had a consigliere who fed her research about content, but now she just does her own thing. She also interviews a lot of people in the space, like doulas, midwives, and lactation consultants. Kathryn thinks that now, she’s more able to do speak about her interests “off the cuff” because she’s just had so much experience in the space.
* [00:34:07] Consuming information and deciphering.
* Interestingly she says that lower-income families do a lot more research, read everything, and are more anxious with childbirth rather than those who come from a higher-income family. So, she tries to recommend evidence-based organizations to help families distinguish signal from noise.
* [00:36:00] Recruiting.
* She’s still figuring out how to best recruit, but one of the things that she has to do in order to really put herself in a position for recruiting the best talent is to interview the person and make sure they gel with everyone on the team, whether they have the skills for the particular role that she’s hiring for, and gradually hiring into the role (contractor to employee)
* Another book from Ryan Breslow which she recommends is Recruiting
* [00:45:57] Favorite guest and learning experiences.
* Kathryn’s question for me! Listen to the podcast to learn more.
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That’s all folks! Remember, it’s just common sense.
— Shree “I will never eat a placenta” Nadkarni
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