Why is Patient Engagement Critical for Better Healthcare Outcomes?

[00:00:00] Jared: Welcome to another episode of the Med Design Podcast where we explore the intersections of health care innovation and technology. Today, we're honored to have with us Deepak Sureshmooc, a leader in the field of digital health interventions and patient engagement. Deepak is the president and cofounder of Sensell Health, a groundbreaking company that's at the forefront of developing digital health solutions designed to enhance patient compliance and drive positive clinical outcomes. With a suite of innovative products since all health is redefining how patients interact with their medications and their care team. Deepak has a rich background as a pharmacist and a found expertise in marketing and behavioral modification strategies.

He spent years understanding and addressing the nuances of patient trust and engagement. His work, which now spans over 11000 citations, spans across the critical areas of customer loyalty, patient satisfaction, and the behavioral drivers that influence health care outcomes. He's also Tai's most impactful professor during his MBA program. And in today's episode, we'll dive into the story behind Sensel Health and the impact of their solutions on the health care landscape. We'll also explore his insights on the role of technology in health care, the importance of branding, and the innovative paths forward for modern health care systems.

And so let's just get started. Welcome, Deepak, and we're very happy to have you with us today.

[00:01:16] Deepak: Thank you so much, jared. That was Quite a bit that you said there. And I'm most surprised and happy to hear about impact on Jared, which is Ty rather, which is great.

Ty's been doing some great stuff over the last several years that I've known him, and I'm looking forward to this session.

[00:01:30] Ty: And you've been such you were such a mentor to me at a time when it mattered That we got the brand and marketing strategy for products from my own personal career. And so I just it was such a joy to have you as a professor, and so it's Fun to have our paths cross again as we start to learn more about what you've been working on and some of the what makes you excited and some of the different ideas we'll discuss today.

[00:01:52] Deepak: Sounds great. Thanks, Doug.

[00:01:54] Jared: Yeah. So just digging into Sense all Health. So what's really the founding story behind it, And what was the unmet need that you were trying to tackle? How have you provided a solution now to it?

[00:02:05] Deepak: Great.

Let me share just a couple of slides. I won't kinda, know, this won't be death by slides, but I don't promise it may happen. I've done a lot of work in areas of trust engagement. I'm a pharmacist, And I was working with a few companies. I was mostly enjoying my academic career.

I was doing academic administration, also doing a lot of teaching for companies. But a bunch of my friends have all started and sold massive pharmaceutical businesses, particularly in the API space and the genetic product space. And We were talking and turned out that there were there was lots of discussion about how badly patients were following instructions, and not simply in care, but even in clinical trials. So a friend had studies come back, and he said, I'm not even sure these people took their applied their medications as a topical product For psoriasis. And he said, I'm not sure these results really hold up for me.

And he said, you're the consumer guy. What do you think? And I started digging into it, and we had learned about compliance problems as pharmacy students, and I knew about compliance problems. What I do not know is how big an issue it had become. And for him personally, he himself had friends who were dealing with skin issues and topical Compliance issues.

And so I said, let me look at what's going on and why these things are so bad. And I looked around, and I came upon the fact that Adherence, or as we call it, a compliance was just terrible. Worse, the solutions were pretty bad or pretty simple, at least. Let me put that way. Simplistic.

And So for 1 example was there's a couple of thousand tropical trials going on at any given time. So 2000 open trials. Hundred and 25 patients just dealing with psoriasis. And over time, the adherence there is super poor. 70 percent of patients not adhering according to CEO of a major company out of Spain.

Major issues going on. And so I said, let's see what's happening in the space. I did lots of research, and turns out 1 of the leaders in the space is doctor Steve Feldman. Steve's at Wake, pretty close by. Steve's up there in the top 3 for in adherence.

And Steve's written and I'm going back and forth a little bit because I think I had things organized. Steve's actually written bunch of books on and articles on adherence. And when I looked at his article, most recent article, this is what he was using. So he'd taken A pill bottle that somebody had with a little open close and these pill bottles, there's hundred companies who make pill bottles these days. It's kinda commodified.

And then he jerry rigged it for his topical medication. So he had taken a pill bottle cap and kinda taped it up to use it for topicals. And so I called Steve. I went I met him actually On his porch in at in Wake Forest. Mister Salem at Wake Forest University.

And he said there's nothing new since then, Deepak. I said this is 20 17 article, Steve. Have you is what have you seen? And there was nothing in the space. So this is when I started researching it And see what was happening in the space.

And 1 of the things I found is that while you have even today, you've got lots of companies with apps and lots of companies with Pill bottle chachkies as I call them. But there's really nobody who was dealing with come plaque medication regimen, which are very important. So 1 is when you need precision. So for example, if you're taking anticoagulant you can't take too much, too little. Modes of delivery or we call these vehicles.

Ointments, gels, sprays where people have to apply it on their scalp. That was the second. Third is where there's titration involved. For example, for mental health drugs, you gotta titrate these Complex dosage instruction. And most interestingly, the regimen.

Seeing a presentation by a oral cancer of a cancer expert at NIH, And oral medications are increasing in size. And as you give these oral medications, they have a very complex regimen. So you gotta take 6 on the first day, 4 on the second day, 3 on the third day. And so I said, if I'm gonna get into this area, I don't wanna do yet another pill bottle for a hundred thousand. Let's go to something big.

And so I managed to have funding in the low single digit millions and lots of support, Lots of great pharmacists who came on, and we said, let's start with dermatology because that's a big enough market. And so that's where we got started. And As we did this, we realized that there was also a problem in chronic diseases. And in chronic disease care, they were you know, you've got you've had lots Some money that's gone into developing fantastic devices and technology for patients. So for example, take diabetes.

You've got a whole slew of Technologies to measure pulse ox, a 1 c, blood sugar, blood pressure, number of steps somebody takes. 70 percent of diabetes patients take oral medications. So if you really want to know how this patient is doing or why they're doing badly, Along with all the technology, you need great technology to also know what are they doing on their primary care path. And their primary care path is medication.

They do other stuff too. Lifestyle changes, food, etcetera. And so this is in a simple way, This just led to the idea that we had 1 focused area that we could go into, which is dermatology. And second is Another larger area, which is complex order dosage forms.

We and so that's a start. And

[00:07:14] Ty: Deepak, could you talk a little bit about Your own background, you touched on it briefly with your consumer trust, but you've got some well cited publication. I remember you highlighted them during our the your class Around patient engagement, trust in particular, which I think that your background on this directly ties into some of the strengths that seems like Your company is building upon. So maybe you could touch on that.

[00:07:37] Deepak: I only got into it because I thought my various backgrounds come tied together, and it's it that's been the most exciting part of it.

So 2 or 3 different areas, if you would. 1 is as a pharmacist. I was a pharmacist. I'm around pharmacists all the time, friends, family, everybody in that area. My master's was a kind of hybrid MBA in pharmaceutical administration and pharmacy.

So I live that clinical side of things. Second was behaviors. Patient behavior going on to consumer behavior, just understanding the core aspects of what drives behavior. What is the role of patients' appraisals of trust and faith, etcetera, in their following directions and their behaviors? 2.

Third was market research. On my own, in my studies, as well as for others, I must have done dozens of market research projects of various types, analysis included. I've written quite a bit. I've spoken quite a bit. And what I did have, which I really came to the fore here, is I had a aesthetic sense Which kind of is there.

I think my family, my dad has always had it, and I always had it. So I think I said, I can put this together. So what do you discover? Sometimes you discover your skills as you go along.

The other thing I discovered finally was What you need, I think, in this space, as you all know well, and you're great at this, Ty, is you need the ability to Connect with people and have people work with you through tough times and good times. And I didn't know it was skill I had, but I think, Ironically, 2 things helped me there. 1 is having worked with young people, MBAs and students and my own Kids who just finished college. I think I knew how to work with young people, and I think that's come about. That's helped me.

Giving them respect, giving them ownership. Right? Making things jumbles rather than dictating things to them. And the other extreme is to work with some really elite advisers, Yeah. Who are, like, in their 1 percent in their areas.

And that, I think, also, I was able to do it because I had 20, 25 years in a university context and working with CEOs on training stuff. I think I knew how to give them the right kind of respect to get them to come in. Essentially, my role then is The founding vision brought partners together over time, developed a product portfolio of 3 products now, maybe going forward. Lots of pilots, divisions. We've gotten a few patents.

Working on the patient interface, because I'll really find that to be important. Putting the core team together, as I said. And then in this last year and a half, it's been lots of the validation work. So several studies published, Thought leadership, validation, regulatory stuff, etcetera. And that brings us to our current stage, which is looking at partnership opportunities and the next step for Sensel, if you Would.

And so our mission was not a med tech. We've never thought of ourselves as a med tech company. I don't think I'd ever get into this if I think I was gonna go into med tech because I was neither qualified nor excited about that. I thought I was going into a place where I could do work that could help clinicians. And so that's been our ethic.

Enable clinical trial and clinical shareholders to deliver these regimen and hit their final outcomes. Now you might get different views from others in the company in our group, but I think We've been fiercely b 2 b. It's been people think that, oh, you're creating this for Consumers, patients are not taking their medications.

And while we know that many of them could use our products, for us, Again, the responsibility I had was not to try to go into a business model where we'd be sunk. And the b to c business model for health care start ups is Just where dreams go to die, as my kids say. I think nothing good ever happens there. Secondly, also, we're enabling the clinician.

From my background, I have a lot of respect for the role of the clinician, particularly for those complex things we're talking about. Not if you have the sniffles or if you just need a Pain medication is your back is off. But for anything with any kind of complexity, these are people who make a difference. And as I look at if I have time, I'll show you is They are among the high most highly trusted. Nurses are always number 1 in trust, and then you have the physician and the pharmacist right there.

So We and the third is the clinical pharmacist. Correct? From where I come from, the clinical pharmacist, I think, are so beautifully trained, whether it's people here at UNC at Ashland, People like my alma mater, Ohio State, or wherever. And I think they'll make a big difference in care for medication, so we trust So number 1 is our market approach is very disciplined, and we've avoided string away and taking small wins by trying to market to this consumer thing or that consumer thing. Mhmm.

Because we don't think that there's a there, if you would. And, again, there'll be a lot of disagreement with what I'm saying, which is okay. Second is our technology approach. So 1 thing was we went kinda semi stealth for the first 3 years, 2 and a half, 3 years, 2 and a half years. Because we said the idea of MVP just didn't appeal to me.

And this is probably the advantage of having somebody who thinks differently. If I'd been a traditional entrepreneur, maybe I'd say MBT. But I said in health care, number 1, I said, where's the energy of showing someone a half baked product And saying this is it's functionally great, but it doesn't have a lot of things, and it's not ergonomically designed. But you can imagine what this is gonna look like, but this is our MBT. And I said, if you really believe in what we're doing, let's take the time and take this to its conclusion.

So that is where a lot of our funding went in, And I needed to have a lot of patience from everyone in the company. The great thing about that is it's led to follow on products, and we literally can has started creating other products from that first product that we just worked and worked on. Second is while we are b 2 b, The products have to be consumer grade in front. So in the end, you've got patients taking them. And, interestingly, whether you're talking to in the clinical trials world, to Someone running a trial or a physician, they are thinking about their patient.

They're proxy for their patient. And they see something that's clunky And bad to use, they're gonna reject it right away. So True. This took a lot of time. Hardware changes, firmware changes, software changes, offline sync.

And I can't tell you how many different things we have to do. And we have to think through patient scenarios like crazy. And finally, you have to be pleasing. If you're gonna build this, why not make it pleasing?

So I'll stop here by saying our and there may be I don't feel confident enough to be talking like I'm sitting on the thirtieth floor because what we've done is very modest and very small, and the team has been modest. But in terms of our approach to work, I think these 2 sets of thoughts about the product and the market have allowed us to kinda stay disciplined And not get thrown off our game, if you would.

[00:14:31] Ty: Yeah. I was wanting to ask you about something surprising from your background in research and trust and understanding of how trust works with patient behaviors and something surprising that's Led to a change in how you're operating this business, and you seems like you answered it with a fundamental focus on clinicians understanding them as 1 of the Great sources of trust. But I was wondering if you could touch on another attribute of trust and how that's driven your overall operating model.

[00:14:59] Deepak: At the clinician level, or you want me to talk about how I think about the patients?

[00:15:02] Ty: It sounds like they're both connected that the I'm curious about, like, how you see both of them.

[00:15:07] Deepak: Yeah. You mind if I just kinda jump forward a little bit? Please do.

Yep. Okay. So it I put some of this stuff together. And as you said, our own research, we've done research with maybe 10 different industries, airlines, pharmaceutical, retail, all kinds of places. And here's a, here's some thoughts.

Right? Which is, first, This is a great piece, Balan. I like the people at Rock Health. Awesome stuff that they do. Rock Health does really good work.

And they did this project with Shamir last year where they looked at digital health. And 1 of the things and I'll point out a few things I see here. Digital health is largely being used for prescription fills, Minor illnesses and mental health a little bit, and then just kinda the complex side, it really isn't being used as much. Part of this could be that when you look at the amount of trust people have, a lot of the trust they have tremendous trust in their physicians, Not as much in the app because it's who's this company who's making it and the website and so on. And this is mirrored all over the place.

We've always known over the years the trust levels with Nurses is just out there. And then physicians and pharmacists as well. Any surveys that you look, you're gonna find that happen. You have talked to nurses. 1 point for me was to say, if you've got new technology With uncertainty and change and challenges you want people to adopt, the biggest thing that dampens uncertainty and vulnerability is what? It is trust. So why are we getting rid of these amazing people? In our field, we have this.

Every not every field has this. Even lawyers don't have HITRUST. So I said number 1 is this is why I said, we've got to that is if this person or these people like what we're doing, value what we're doing, and recommend what we're doing, Then it's essentially trusted people talking to others. Also, you gotta allow them therefore for them to say what you're doing is not great. It's okay.

But if they like what we're doing, then they become tremendous drivers of adoption and use. So in fact, I put a model together which I call virtual second. I'm saying virtual should come after the real connection. But, I'll skip my model. I don't think we have enough Yeah.

I'll geek out on the model if you don't mind.

Okay. If you want to, then let me just say in 2 steps, there's a whole paper on this, 50 page paper, which so 1 is why does trust make a difference? Number 1, Trust brings down risk, ultimately, like we said. So if you wanna see innovation adoption, moving from r 1 to r 2 Would essentially get the patient from here to here.

More adoption. I think the second part is risk never goes away. No matter what, you're doing stuff with a little risk you don't know. There's an even flying on a plane. Even you go with a trusted pro like Delta, There's still risk in going up in the air.

So the second thing trust does, it allows you to accept residual risk and say, let me try this Because the person telling me is trustworthy for anything. I had shoulder surgeries and hand surgeries for my tennis hip arms. But half somebody says let's do an epidural. Somebody else says let's Surgery. A third person says let's do physical therapy.

Fourth person says let's do MedROD. Those facts. Now all of those have risks to them, But my acceptance of it is partly driven by who's talking to me. So a simple model then is essentially Ty, is Step 1 is it brings down risk, and we're willing to do more. Second is you accept risk, and therefore, you're willing to do more.

So Your willingness to adopt something goes up through these 2 pathways, if you would. Mhmm. And here's the other part. You said what are the facets out there?

So in a lot of the research you cited, 1 of our papers which had 6, 7000 citations, we broke trust down into what exactly is there. And there are 2 pieces to it. 1 is sheer competence. That is you're really good at what you do. The other side is what you could call benevolence or caring.

That is you care about me And I think these are the 2 parts of trust, which is what all those people bring, which a digital health company can't simply go give it to them. You need this to be virtual second or digital second. And finally, the good news is lots of people agreeing with it. In fact, Sachin Jain, who's both of these people. Jennifer Schneider and Suresh Bhutan are physicians of their big companies.

And 1 of them said, here's an article saying health care is different And time to put the comparisons down. And then Jennifer Schneider said hybrid care, which is providing convenient access to personal touch is the biggest challenge. And she's got a company called Forward, which is out there in the rural markets, and that's what she said. But I think there's convergence around this, and I think that digital health people may or may not like idea. But in my mind, I think the all of the you can see how this goes together.

There's a team here. B 2 b Provider focused using trust as the basis and building trust and why we went out with a non MVP. We went out with almost a market ready product. Our products are there Because we didn't want anything to undermine what we're doing, and it's put a huge burden on us time wise, cost wise, pressures wise. But we thought this is the right way to do it to be I hope that was interesting.

[00:20:13] Ty: No. It's fascinating because that's real it's such a foundational attribute between how you've Entirely set up your company and the leadership team and tying into those sources of trust. It's an entire strategy that's based around what can we do to maximize trust. And it's not something you just go and put coins in the jar for kinda like you'd spend a little PR budget, but it's like it's it has to be part of the core founding DNA of the organization.

[00:20:38] Jared: We have a couple of Questions also in the chat that I thought were really thoughtful, really good. 1 actually being about the trust conversation. And so do you see that as part of the reason behind the apprehension of patients, providers, and nurses, etcetera, accepting AI to help with care. It's because it's not built on the components of trust that you've just been discussing.

[00:20:58] Deepak: I don't know enough, but I'll give you 2 little thoughts on it, Jared.

I'm not on top of this enough. Number 1 is, I think just the word AI is like a scary thing everywhere. And for some people who don't know it, it's, gosh, Who's making my decisions and pulling my strings. For people to know it, it's like how long before we end up in singularity or whatever. So there's lots of people scared.

I think in terms of accepting AI, I don't think patients will ever know that AI has made its way into the products and solution they use. It already is. Yeah. So and just like people don't know whether they're looking at deep fakes and such.

So I don't think just like components. Patients don't know, For example, that some of the components of their products are coming from China or coming from wherever. And similar, Apple is made in whatever designed in California, It was made by Foxconn in China. And so no matter what people's apprehensions are about China in various ways, particularly on the war front, There's nothing they could do because they really didn't know. So I think AI as well, I'm not sure people will ever know it, Nor is there gonna be a disclaimer saying this product has an AI component.

It is so ubiquitous and embedded in it that it's gonna be there. If anything, again, it puts the burden on whoever is using the product to make sure that it is being done in the right way. It's being done in the most efficient kind of way. So I think my answer is I don't think acceptance of AI for a whole lot of products. Right?

For a whole lot of products. I think it'll apply for consumer products where it is who is it designed by? You want a painting of a lion, then you could ask AI can design it Versus you could actually go to an artist who'll take 3 weeks and paint you the lion. I think that's where you have acceptance. Do I get the human thing, or do I get the AI thing?

I think in health care, it's all just a mishmash. In drug development, for example, today, whatever drug entity I'm gonna see in 5 years, How do I know that today it's purely at the bench and there is no AI driven machine learning component behind it? I just don't, and I think it is there.

[00:22:59] Jared: So I would really also just love to hear about the solutions that you've developed as well. So it's around dermatology, chronic care, and complex therapies, and so A lot going on for such a small company.

And how did you even accomplish all that, and how are they working together as a comprehensive solution?

[00:23:16] Deepak: Let me walk you through a little bit, and you can just jump in and cut me off when your time is running out. So number 1 is we had to make a decision on since we're talking about innovation. We had to make a decision on how much to innovate and what kind of innovation we're going to do. So I pulled this out of my slides from a few years ago, I think, from my Initial pitch.

But I think 1 of the questions we have to have is, so let's not do something if you take commercialization risk versus value, Down here of where all the there's a 600 companies who make bottle caps, okay, pill bottle caps, and apps, and self reporting stuff. So the risk is low and the value is low. Let's not go there. The other extreme is super high value and super high clinical value and risk. So there was a company called Proteus, which was out there.

Proteus, unfortunately, it was valued like a unicorn when we started and then had to close and go bankrupt. Proteus actually devised a pill that would go into your stomach. Your gastric juices would melt it, and it would send a signal to your Bluetooth to say you took the medication. So if you really wanna know if I took the medication, that would be the ultimate. So he said, let's do something in between where we know we take a big enough risk, But we increased the value.

And I think the key to innovation is to have a disproportionate value to risk ratio. How can I do something small that increases my value like crazy? Most crazy example of this would be, the piano versus the harpsichord. The harpsichord had been around forever, and Bach was composing on it. And then the piano came along, which is a small change.

It went from pulling strings to hammering on strings. Small change in technology and massive change in value. So I think that's what we should be looking for. So as I said, we'll said let's look at complex medication that we want to go to. Dermatology for us seem let's become the number 1 company in a small space.

And, ironically, although you've got 2000 trials going, If you look at the total number of prescription and number of trials, dermatology is, I don't know, 7, 8 percent of the market, maybe 10, 12 percent, somewhere there. So relatively small. But this is where, Jared, we took forever and built this product and proved it out Got our patents and tested this like crazy and got the app and everything else working. Oh, and so then here's the way we are. Right?

So we said, let's differentiate Ourselves. So I think we can claim here. We are the only 1 doing topical meds with direct measurement as a dedicated product despite anyone at the market. Then we saw the other market before COVID, but certainly during COVID and post. But huge companies like Omara, Livongo, Juco, WellDot going into this market, Which is for oral dosage forms in chronic care where we said, but here's another problem here.

They really don't have a great way to know exactly how much the patient took And a way to vary that and get the analytics on it. So then we developed our follow on product, which was developed at 1 third the time Of the other product. And this and now we have others that we expect. And depending on who we work with Who wants to help us develop products? We've got a family of products that's being developed off our core product.

And so this is our way to get into a larger space, if you would. So this is the only product that'll tell you exactly how much you took And also measure the exact temperature at which you're taking it, lots of other data that you get there. And we've got 2 studies currently happening. 1 about to finish with this product. We validated this at the University of Houston, independent of us.

They didn't tell us what they were collecting, what kind of data, and they go under the IRB at the University of Houston. And we had after they were done with the study, they compared it to our data. And I think there's about 95 to 98 percent concordance between Their measurements and us. For example, if they took 3 pills, what did we capture? If they took 2, what did we capture?

If they skipped, what did we capture? And so on. So these are the 2 products, Jared. And our 2 target markets then are the clinical trial and the care market For topical and oral dosage forms, and that's been the trajectory. Things have changed.

There's been other products that have come along since then, At least derivative products based on opportunities. But I think I'll leave it there by saying those are the 2 markets and 2 products that we build with Everything underneath it. So with so for example, for each of the products, it's got and these have been codeveloped, so it's not like it was an afterthought. Essentially, if you say where does the value for our products come, I think it comes through using everything. But we become comfortable using just 1.

For example, In a couple of studies, people said we just want your devices. We really don't want the patient to be using the app and find it. But, ideally, it would be the whole things, the analytics And all of this. So if you wanna think about it, it's our platform that we use. And if you're fine, let me just talk a little bit about platform since you had asked me about platform idea.

And I think this is where, again, I'll disagree with what some really great people are saying, so I might be wrong. They may be right. You hear a lot of people pushing back on point solutions To the point of making fun of people saying, oh, there's too many point solutions we need to find. And I have a couple of thoughts there. Number 1, If everybody developed a platform, how would they ever gonna integrate and come together?

If you have someone with a major platform, Everyone else's point solutions need to play with that platform. In other words, a great platform is really looking for point solutions that can integrate. Number 2, as a small company, the small sharp start ups in the area are all good at something that they do. And why not have them build their best point solution, and then you find a way to integrate it into existing platforms? The last thing you want is a hundred platforms.

And so you're gonna have what platform to platform integration, and it's craziness. So while we built it, while I would say that we have the platform, And, for example, in our current studies with for example, it's Steve, doctor Feldman at Wake. We use all of this. We enroll the patients here. We've got Lots of error reporting, dashboards here.

We got all the data coming in here. We've got the apps that the patient can use, and then we are using Both are devices in various studies. So we have a platform you can use, but I frankly think We'd be fine to play with someone else's platform. So I see platforms in 3 ways. And people use the word platform so much that I think it might be losing meaning sometimes.

The classic idea of platform that I learned and thought about and worked with companies on was technology platforms. That is like a dominant design like ours. Like a Common a prod like a chassis. For example, Toyota has their platform, and the Lexus was kinda built off of the Toyota platform. And people are unhappy a little bit with it, but that's what they did.

Volvo got its platform, and Gigli acquired them for the core platform, and it Kinda applies to lots of Volvo products. Volvo cars versus the Volvo truck line. So I think technology platforms are products that all share something at the core. So there is efficiency in development, and you can be launching lots of new products as you go along. The downside is that if your platform becomes Obsolete, and the whole thing becomes obsolete.

That's a risk you take platform. So I think we built this platform. The second platform and I'll skip the 2 sides. I think Platform in health care I was just listening to a presentation before I joined you guys from some of the company, and they were talking about how they have a platform. I think people these days don't wanna say they have a product.

I think everyone wants to say I have a platform. As if there's a lot of respect somewhere by saying we have a platform. So we have it, And I've sometimes used the phrase and gotten to say, yeah, we have a dermatology platform. But I think platforms in health care mean you have a total solution. Portals, app, dashboard, and Software.

And I, again, see the pluses and minuses of it. A company like ours, unless we really own the market, Cannot have this and tell people the only way we can collaborate with your technology like, for example, let's say someone's got a technology that can scan your skin And kinda give you a diagnostic on whether you've got any kind of a either a dermal issue or potentially even dermal cancer. There's companies out there who are doing this. Great companies.

So let's say someone wants to combine a diagnostic that can look at your skin and tell you whether you've got any problems with your Good. Atopic dermatitis, keratosis, whatever. And then you've got our product that can tell you if you have a problem, you start using the medication, we can make sure you're using it right So that maybe in 6 weeks, you can again take another measure and see how much the patient improved. This is actually a pilot study I'm describing to you right now. Now if that company has a platform and we have a platform, I think we should be ready to join their platform either if they're a major player Or they're a dominant company who's wants to financially reward us more than we can reward them, or let's say they've got a better built platform.

So I frankly think this thing about point solution and platform, maybe it's just right for me to write a piece, has to be rethought Because I think platform should be modular, allowing you to become a point solution player. And I think it's fine for a company to develop point solutions That are just the best in breed, best in class, and a platform player can cherry pick and add on to them. I think the pushback on entrepreneurs and start ups To say, but all you got is point solution and this point solution fatigue, I think, is misplaced. And so here's what we built, and I'll leave it there, Jared. And so

[00:32:33] Jared: I would actually be curious to see what the other contrarian points on that would be because I feel like that kinda makes a lot of sense in my mind.

And so I think and I wanna talk about your branding and go to market strategy as well. We don't have a lot of time left. And so I guess Joe, in what ways do you think Marketing go to market is different in the health care versus pharmaceutical industry versus consumer retail. I'm sure that's like apples and oranges to some degree. Yeah.

[00:32:58] Deepak: I think I've covered it by saying, and just like the other experts have said, that this isn't your typical consumer business. I think health care partially is for a lot of people is a grudge purchase or they're kinda reluctantly involved in it. Not anybody wakes up saying, man, I can't wait to get to my insulin or to get to my 17 medications for my chronic disease. So I think Health care, you gotta think about health care as you gotta deal with the non engaged patient. That's the critical part of health care.

People want the patient engaged, and there's so much about let's how do we get the patient engaged? And I think we should give up a little bit and say, let's find a non engaged patient To still do the right things. And I won't go into the details on it, but there's ways to think about it. And I think this comes back to just the last couple of slides, and I'll wrap up on this particular topic, and we'll wrap here if you want, is I think there's a dichotomy here in between consumerization, direct to consumer, which is what you said, Retail and going retail versus being consumer grade and consumer friendly. So we wanna be that.

What our end product, as I said, We want them to be consumer friendly, easy to use, and consumer grade. What we don't wanna do is, from marketing standpoint, go Direct to consumer because I don't think that model works. And the other challenge in health care is just this, and I'll end with this if you want, is I think the biggest challenge that you have is What is right for the patient is not often right for other stakeholders. Sometimes not right for the clinician or the clinical operator. And it's also not right for the engineer who's building your products for you.

So I think the negative the inverse correlation sometimes between what a patient may want Which is what a physician wants. It is something that you've got to you've got to keep in mind. But even use some think about something like direct to consumer advertising that companies do. There's so much back and forth, and the rules have changed. Because on 1 hand, you might say the patient wants information on all their medications.

The clinicians said, on the other hand, the patient may overweight the risks and not wanna take a medication. We know that better, and so we don't want to be the 1 who will Give up the right on using these medications to end patients. So I think that the dilemma with being patient centric Is the potential negative correlation between clinicians and physicians, pharmacists, and their and so and their patients, for example. And so that limits how much can be translated into from consumer market. I think there's a limit to that, and the idea of consumerization Is and the problem there, I think, in the end is you want an informed individual as a consumer making a decision, an informed consumer who's making decisions about which airline to fly Or which refrigerator to purchase?

They're engaged. They like making a decision, and you can therefore market to them. And they're kinda keeping an eye on what are the brands out there. Health care is not that way. And so I think you can't use that model in the health care market as much For again, maybe more on the complex side.

As you saw, a lot of telehealth, for example, ended up on the low end side. So I think on the higher end more to higher end of Health care. I think the model that threads the needle right and that kinda goes through the clinician He's ultimately the ideal model that can work is my sense on this. That's my thought.

[00:36:19] Ty: I was curious if you could then shift now to talking about And your perspective from the nuance of how to appropriately use platforms and a modular understanding and then point solutions in that role.

But then more broadly, the vision for where innovation generally goes. And because I think the implications of that, from a consumer standpoint, Saw the platform plays of Facebook, PayPal, where it was just acquire users at all costs Yeah. Kind of model super standpoint. Health care doesn't allow for that. And I'm just curious if you wanna extrapolate, maybe more broadly about kind of innovation plays within health care.

And I think there was some also some other organizations you were particularly excited about that maybe you can touch with Hatco and whatnot.

[00:37:04] Deepak: So just Yeah. Okay. Great. I think there's 2 extremes.

There's 2 ways of innovating that I see. 1 I never quite liked, and therefore, I think you see that reflected in what we've done at Tencel, which is this idea of disruption. And Disrupt itself is poorly understood. If you listen to the classic work by Christensen, who came up with the idea of disrupt, it's a very different idea of disruption. Disruption is more going to the lower end of the market and etcetera. Almost like the bottom of the pyramid kind of idea. I think I see I think in health care, if you ask people about Disruption. People's resumes. LinkedIn says I'm a disruptive something.

I think they're thinking about being a radical innovator. That is I'm doing something so different That it's so different from what exists out there. Maybe that's 1 model. I think the other model, the 1 that you can see that the reason why I like what HATCO is doing and what John Habel called shaping strategy is where you are respectful of the current context. And I think you're respectful also for health care providers, people in the space so that your innovation you could still do something pretty impressive and different.

You're still not doing anything incremental, and we are not doing anything incremental. But you're doing this in a way that is non quote, unquote, It's disruptive. It's not like you're I forget about the phrases, breaking things and, whatever it is. So I like that model, and I think you see that reflected in everything I've talked about today.

And the reason why when I saw what a general catalyst was saying about how to go and in fact, even Jennifer Schneider, who talks about forward, She's also had investments from General Catalyst and all. She was at Teladoc before this. Now I think you're starting to see a sense of let's get this right By not just repeating what we've been doing so far and that's failing. Digital health has made small strides, and you can see that. You can actually see in the data I showed you.

It's at the very low end of the spectrum. At the higher end of the spectrum, I think you've gotta do this with in the shaping way, In the HATCO approach and I think with a lot of respect for the clinician, and I as I call it, and I'll probably write about this, I call it virtual second. No. I think that is the model, the virtual second model. We'll actually get more digital and virtually used.

So I think it's a go slow to go fast model, which I taught my kids in tennis. Slow down. Let's get everything right here. So I think it's a go slow to go fast Shaping approach, the Hatco approach that's gonna win.

And someone's gotta take that position, and I'm taking that. I've always been against the idea of disruption in the new way. Christensen's disruption is very fundamental to markets. That's the only way markets can grow, in fact. And it's not even I don't know why he the word disruption is kinda misused, But that is brilliant stuff.

I'm against the new quote, unquote disruption of breaking things. And I think the vision that I'm suggesting and the other suggest is Not as exciting, maybe. Not as romantic. Maybe not things that keep people up all night, and this keeps me up all night. But I think it's the right way to go.

I think it's alright. And I love the convergence. There's also bunch of others besides John and besides the ScanHealth chaps and besides the GC people We're all saying the same things, and maybe it'll become a bit of a trend or a wave, hopefully.

[00:40:12] Ty: In the radical innovation, let's call it. Not the Clayton's and disruptive, but radical innovation carries a trust burden, a trust cost.

Because if you're asking somebody to do something that's scary and new, You have to work that much harder on the trust end in order to overcome that cost versus make it so that it's more approachable and less of a difference for The people you are asking to change so that you're reducing that risk on their end in order to adopt what you're offering. Is that framework? Is

[00:40:39] Deepak: That's part of it. There's a lot there's a couple other things Really quick. 1 is, if you look at the role of the physician, not just the Hippocratic oath they take, which is to not just do no harm, but in general, they're actually saying do no harm as long as the Benefits are worth it.

We can do a little harm. Right? Medications have harm. Surgical procedures have harm. So they take a guide risk there.

And I think, therefore, they don't wanna take a massive risk without knowing if it's gonna pay off, number 1. And number 2 is this. Take another model. Take Google. Hey.

Google Search. Google Search is still the dominant money earner for Google. Have you seen a disruptive change in search over the last 10 years? No. It's been seismic.

It's been under the hood, but it's been seamless. They've been making changes. They had the hummingbird algorithm. They've changed algorithms over Fine.

But they're essentially saying that if you've got something good going, let's improve it, but let's not disrupt. There have been disruptive companies. DuckDuckGo tried to disrupt. But I think Google has been making changes, evolutionary changes that have gone along. So I think there's lots of models.

And I think in health care, You're also trying to tell people to take a risk with you, but they'll only take a risk with you. They should take a risk with you only if they know it's gonna pay off for them and their patients. There is no oh, let's take a chance and it crashes. We can do over. We don't have that approach.

You don't there's a huge opportunity cost in health care. And, therefore, I think this is why this model, I think tied to your point. Why radical is the right word, actually. Radical is so much tougher and Probably not even the right thing to do unless you're trying to make your investors and private equity folks really happy by saying this is so novel and Different. It's gonna change the world.

I think in reality, I think we've gotta be a little more honest about what we want to achieve here. So And patient. You can be, like, frustrated with the problems that we face in health care because it's a problem rich environment, but have the patience to do the right things to build the trust, To not just rush a solution out there, but to really do the due diligence to make sure I've been Yep. Still push. I think the technology folks are still the ones getting innovation and new ideas in health care.

And I think you still need to open their eyes to what can be done. Open our eyes. Open their eyes to what can be done. So there is a role for marketing and kinda Not just kinda sitting back, but actually being a leader there. I think you should be a leader, except you should lead in a way that you can bring them all along with you for the ride.

I think that's important. So that's my overall feeling on that whole space. I think we should have booked Maybe a 3 hour conversation because there's so many questions that I still didn't even get to ask you. Thank you. I just say thank you so much for your time today, And I'm greatly disappointed that you're not teaching anymore because I would love to take some courses from you. I've definitely learned that, man.

[00:43:20] Jared: You are just a wealth of knowledge, and just thank you so much for taking some time to share it with us today.

[00:43:25] Deepak: You're being super kind. Thank you so much, and thanks, Ty, for the time. I look forward to catching up in person very soon.

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