Maximizing healthspan using behavior hacking

Chris:

Hello digital health community. I'm so excited for our guest today, Ravi Komatireddy. Ravi is CEO of Daytona health, a new startup, doing what he calls behavior hacking, a culmination of years that Ravi has spent researching, starting and advising companies and evangelizing around behavior change and motivation. Ravi is a serial entrepreneur, a speaker, and has been hacking digital health himself as the Chief Medical Officer, founder and CEO of several startups. Ravi, I'm super pumped to talk to you because the graveyard of digital health startups is filled with great promise and seemingly great technology that couldn't get adoption with the people that matter most in the equation, which is patients and you're cracking that knot. I know we have a lot to learn. Welcome to the podcast. Can you tell us briefly about yourself?

Ravi:

Yeah, absolutely. Thanks for that incredible intro, Chris. So Ravi Komatireddy,  internal medicine physician by training from the Midwest and originally, I but I trained on the East Coast and finished training in the west coast where I was able to do both practice medicine but also kind of quickly sucked into the intersection of technology and healthcare under the term wireless health as it was called back then, which evolved into digital health. So I had a research role, did a fellowship over it with Scripps at the time it was called Scripps Translational Science Institute and the West Health Institute. But also just fortunate and lucky enough to be involved in the founding and evolution of two companies Loom IATA and reflection health, then took some time off to do some other work outside the United States. And then just putting off my own mental health and my own health issues and came back to create Daytona health.

Chris:

Awesome, so you're a physician turned entrepreneur? And I love unpacking those journeys to entrepreneurship. It sounds like, I don't know, is entrepreneurship something that you just had in your master plan from day one? Or is it something that you stumbled into just right away, and you thought, oh, wow, this is me, you know, more than anything else. And I'm just kind of interested in what that journey was that took you from the Midwest to Silicon Valley.

Ravi:

I think the number one reason for all of this to happen. And things that have happened to me. Now I'm aware, a psychologist had this thing called retrospective bias where we just make up the stories, and connect the stories that connect a little part of the stories together to create a whole narrative. And we know that such things just happen by luck and chance, and you kind of put your foot in the door and don't let people close it on you. And so you just get these opportunities, because you're just persistent or just in the right place at the right time. A lot of that, right. So but but I will say what the one unifying factor, beneath it all is curiosity, I would say if my friend said to put one character trait on, my on my tombstone, in the digital health graveyard, it would be a curiosity. I'm just intensely curious. And my drive is to figure out, I get frustrated easily that my drive is to figure out why I'm involving myself in systems that don't work as well as I'd like them to. I think we've all had that drive. We've all either been in jobs or been in things in life, where we just go, why am I doing it this way doesn't seem to make much sense. And I think there's people who could just capitulate to that and go, you know, I'm gonna make the best of it. And I'm going to, chess is a, this is a chess game. It's got rules, the board is confined, I'm just going to be the best chess player ever. And just figure out where, where I can, where I can excel. And then there's other people are like, I just don't like this game, let's change the game and petition to change the game or create a new game or do something else more disruptive. I happen to fall on this. So I am just curious on what the other possibilities. And the vehicle that gets me answers just happens to be entrepreneurship. It's nothing I aim for, per se, like I didn't, you know, in high school, I was gonna start a company be a CEO, this is not gonna happen for me. I can, I can understand how that probably could have happened for a lot of people who just want to go on the career path. I was like a scientist, doctor, you know, but when you say, just basically dissatisfied, disgruntled, or with a doing thing. There's always some outlets for that. Right? So

Chris:

Yep, yeah. So instead of staying disgruntled with the current system, go ahead and be a change agent for that system.

Ravi:

Yeah, he's a dangerous door to open. Because once you open it with entrepreneurship, the sky's the limit and what your mind can dream of all these impossible things. And so you get supercharged by it. It's almost like, I think you have to be a little rational to be a founder because the odds are stacked against any company being founded by anybody. Because there's so many things not on your control. So you have to be blissfully optimistic, and possibly ignorant of all the challenges otherwise you wouldn't ever start

Chris:

Right, got it. Yeah and you talk about this keyword that always rings bells in my head, which is curiosity, right? And at Persimmon, when we're looking to work with anybody within our company, that is the number one trait that we look for, right, which is the, you know, just this innate quality to be frustrated with not knowing what something is or what the best way to do something is because we see when people have that trait, it's it's setting them up to grow the fastest because they're always going to be striving for that continuous improvement and self learning. I'm wondering, as a curious person yourself, is that something that you look for and people you work with, like your co founders and such? As you've matured into many companies?

Ravi:

It depends on what stage and it depends on what role, you know, I think, and this is just me taking a stab at what I see is we divide people to big groups. Okay, people have different temperaments. Some people, like are really good at making sure the trains run on time, order, discipline, focus, the COOs of the world, and you need these people. Without them banks don't run, you know, organizations collapse, and there's no discipline on everything from spending to innovation, all those things need to be tempered. There’s also another group of people, and I say this word affectionately. I call them weirdos, in a unique way, you need these people who are weird, they're going to dress differently. They'll speak differently, they're into things that most people aren't into. They have an odd thing about them. They're in their own world, most of the time. Those people are responsible for a lot of innovation. Some cities breed people like that, I would say San Francisco in the tech area there in the tech scene in the startup scene breeds that and kind of cultivates it, which, which is what makes it so special. And good companies, you know, different stages need different proportions of both of those types of people. So you're a $3 billion company, you better have people running the trains, make sure they get on time, because that's really important. You can't just be running rampant innovation and spend all your money on an r&d budget. But in the early stages, you know, I do look for more of those, let's just call them weirdos. The more curious type, I kind of fall with one on one leg in both those, were all everyone's on the spectrum between those two temperaments, I guess. But I tend to gravitate more toward the more curious, more disruptive people at this stage. Because the nature of startup operations and use of resources is that you're going to burn through cash and resources, no matter what you do. You might as well be if you're burning through cash, not learning anything, that's a complete failure. So if you're burning through cash and resources and time, but you're learning something, that means you're trying new things, and you need to think innovatively, and I believe that's, that's what I do look for those curious people, those people who are disruptive, who are not willing to stop innovating, because these are this is hard. There's, especially with a digital health startup, you're spanning several domains here, very complicated knowledge bases, the business operation side, the science side, the medical side, the health system side, this very complicated, each one has its own domain experts. So you need people who will stay curious and help you innovate new solutions when something doesn't work. That's the whole startup advantage, is that you can quickly and figure out, you know which decision trees ended up at a dead end? Which was worse?

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Chris:

Yes,  Absolutely,  yeah and I think you mentioned one of those, you know, most relevant pedagogy’s  in the startup world today, which is kind of lean startup where what you do is you prioritize the speed of learning, less so than the speed, necessarily of features or outcomes etc. Because you know, if you learn the fastest and you as an organization adopt that learning in terms of product, that you're going to be stepwise, making progress towards product market fit, instead of just wandering around step guessing and checking just randomly. And I think that's awesome. And, you know, you've been now you've started this journey again with another company Daytona, and I'd love to unpack that but as we get into it, I'd love to ask some foundational questions that will set up our audience and myself better to understand what the tuner does better. So talking about behavior change, he talked about precision, health behavior change, what is precision health or behavior change and why are they important?

Ravi:

Right? behavior. This is a loaded word. Let's just say, let's use the term lifestyle change for now. The reason well yesterday for questions, so precision health, it's interesting. And we talked about precision health, precision medicine a lot. It's about tailoring interventions based on the factors related to each individual patient. So those are genomic factors, genetic factors, environmental factors, the belief systems and goals of that individual person, along with whatever pathology they may be experiencing, or in terms of health and prevention, whatever goals they want to achieve there. So we know that in we know that, especially when it comes to things like temperament, personality incentives, belief systems, and their goals for their health people are different. When it comes to behavior change interventions. One of our goals at Daytona is to create a system that personalizes interventions for each type of person in their specific context to help them achieve those goals. Now, the reason we focus on lifestyle change in general, and I want to zoom out just even even broader than that, actually, to put this into context, I think the best umbrella term, which encompasses what we're aiming for Daytona is to help people maximize their health span. And by healthspan, I mean, specifically two pillars. One is either delay, definitely improve, or reverse this cluster of cardiometabolic diseases, which is so pervasive in our culture, is diseases of lifestyle. To some extent, you know, hypertension, heart disease, stroke, diabetes, metabolic disorders, obesity, and if you include things like smoking and things like that cancer, COPD. The other pillar is to help people with their longevity, and their performance. So you want to help people live longer, more productive lives. So healthspan Is this , the cumulative number of years where you're really thriving, I think the nightmare for everybody is being disabled to the point where you have little cognitive ability, and you can't do the things you want to do. That's, that's, that's what everyone's trying to avoid. When I look at how we can do that, to me, we've built a system in terms of our healthcare system, that is really good at putting out fires, and is able to do kind of end of life interventions, or really serious interventions with medications and things. But it's not so good in helping people live longer, better, is it,  especially not with the initial part of delaying these disease processes. Now, if you look at why we think it's because of two reasons, we're not looking deep enough. So this functional medicine approach, looking at the root causes of why we have these diseases in the first place, what we can do about them. And second, when it comes when it looks at, we really take a look at how you can intervene here, lots just happens to do with lifestyle. A lot of it has to do with sleep, exercise, nutrition, mindset, and mindfulness. And when it comes to performance, not only are you looking at those areas, but you're also looking at improving your skill set. And things like time prioritization, and stress management, How do you manage teams? How do you thrive at work? And we realize all these things are trainable. And they have to do with changing or helping people empower people to change alter their behaviors from suboptimal , which they're doing now. into more optimal behaviors. So that takes a team. So we thought, can we put the right team with the right protocols in a way that can personalize a process, essentially, really successful people, Chris, how the systems that they invest in that give them results consistently over time. That's what success really is, you want consistently good results over time. People have systems like this when it comes to every other part of their life, but they don't have that necessarily when it comes to their health. And that's where we come in. So we essentially are trying to serve as your system for getting consistent results with your health, longevity and performance.

Chris:

Got it, so lifespan is something that health care is optimized for so extending literally through treatments when you're in trouble to extend your life and then healthspan is prevention of you having to live with those chronic diseases or your ability to live a healthy life regardless of those diseases, and then behavior change is that change in lifestyle and then precision health is the means for tailoring behavior change programs for interventions for an individual. Now that makes a lot of sense. However, when it comes to behavior change, this is something that that Graveyard of startups has been cracking on for a while. Why has it been so hard for our industry?

Ravi:

Because I think most behavior changes or interventions. So let's talk about persuasion and behavior in general. Humans know how to do this in every other industry. So we're not living in a world where the science is not well described, where there are not teams of people, behind the scenes at Netflix, that know with high degree of confidence of exactly what I'm going to watch the next five minutes on Tuesday, right? So we know those exist. And that level of scientific knowledge, where you're able to compute a behavior vector on, you know, at what you're going to add to cart, the Amazon homepage exists. So we do know how to do this coaching exists as a group of experts of expertise, who use tools and techniques to help people improve upon tasks we know that exists, we know that works well. The most obvious, the most obvious form of that is in professional sports. So we would never argue like none of us would argue that professional sports NBA coaches shouldn't be paid what they're paid. We say, Well, of course there will. Why? Because you're able to impart skills and motivate people in a way where they're getting persistent performance. But now, let's just take that. So what we're saying is, let's reverse engineer what's working there. What are those coaches doing? What techniques are they using? And how are they applying them? And in what context? Can we transfer that knowledge into health care? So I think that's step one, that's hard to do, then you can do it right now by just hiring really good health coaches, which are excellent in doing this. And they have that, which leads to the second problem. We're trying to fit behavior change interventions, typically, within the context of the time afforded to us by the traditional healthcare model, we're talking 15 minute clinic visits very brief sessions, maybe four times a year, the average, the average clinic visit, the United States for primary care is around 12 minutes. And the average time before a physician cuts the patient off from talking is 12 seconds. So you just don't get time with your clinical staff. That's been the number one complaint of patients has been for years. And the average number of times you'll see a primary care physician over the year, the average is about four. So you're talking less than 60 minutes of total intervention time. Now, how in the heck can anybody in 60 minutes, other than just telling you, hey, you should be losing weight, man, I really want you to exercise that’s not behavior change. And about a third to a half of physicians report that they do that. And I think they're at their wit's end, too, they understand that these interventions need to happen, they just are unable to deliver it within the confines of the system they're working in. So that's problem two. Problem three, is I don't think they're trained to do it. And I can, I can say, this is a physician, you know, we're we're very good at a certain number of things. And a great physician is absolutely irreplaceable. But, you know, health is a team sport. And we've been playing the solo for a long time, as if we're the only the only voice in health care, right? I mean, using medical school and our clinical experience, to understand what health means to people. And it's in a holistic way. It's like an astronomer, using binoculars to look at the sky. It's a very narrow view. And it took me professionally a long time understand this as well. There are other people like health coaches, dietitians, personal trainers, people who are experts in motivating and using the right techniques and the right people who know how to do this, we need to engage the rest of the team. So you have experts that are hard to find who are really good, you're they're not really incentivized or integrate well with the current system. And the current system is dominated by people who are effectively not incentivized, and unable and not trained to deliver some of the most effective interventions for the diseases that are affecting the most people. So I think those three problems coming together is why a lot of these startups if you're just trying to get doctors to do it, it's not going to work. If you're getting health coaches and stuff to do it. Okay, But you know, you know you're running an assembly line with the healthcare system, you've essentially turned the world's experts in behavior change into an expensive call center. And that's not going to work either, right? So you have this, you have this paradox of how do you we, I think everyone understands that if you have a good coach, you do better. If we all had Oprah's bank account, we had personal trainers, you know, live with us or the rock live with us, and to motivate us every day and work out we'd be fine. We all do well, but it's how you scale it. And that's been one of the challenges. Every time it's been scaled so far you just, quality starts to reduce the engagement starts to suffer

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Chris:

Right, yeah, you're talking about one of those nuances and with digital health of course. Now you're no longer limited is term to impact for the patient by the number of minutes in an encounter, but that brings up the question in this new modality, what is the right combination for behavior change? What is the role of humans? What is the role of patients? What is the role of the health system? What is the role of coaches? What is the role of the physician in terms of providing that best care towards improved lifestyle? And in fact, you had a tweet about this right? Which opens more questions, right? You said I think he said with digital health, the right answer is often throw humans at the problem. First set of technology, but a 30 minute phone call by a healthcare professional who listens and cares to tends to solve problems faster than AI? Philosophically, what do you think about the likelihood ,the right secret sauce blend of these things? Are you trying to find that

Ravi:

We're converging toward the right blend and mix of touchpoints. for each member. I'll let you know about the tweet. And I'll take a stab at your other question, which was, you know, what's the right combination? Okay. The tweet came from some frustration, I think one of the things I've learned, and I'm still, I'm still holding the skill is to figure out exactly what problem we need to be solving. As a startup as an individual. I think that's actually the big one of the biggest problems startups have is they think they're solving a problem for a lot of resources, millions of dollars into it, they're actually not solving that wasn't a problem. They're solving like, Oh, crap, we figured that out too late. So one of the problems if you're trying to get information from people, you can throw technology at the problem and figure out a conversational bot that's so complicated with its language model and semantic analysis is NLP. Now, you have three engineers, or you just have somebody call them. Go ahead. How you feeling today, you're having chest pain, or your leg swelling up? How did you know what  would you eat this morning, it's just . So I'm just saying I believe in technology is a tool set. And I believe that he you know, it's just about applying the right tools to the right situation, I'm not so in love with AI to the point where I think it should just replace things because it's, quote unquote, better. It's something I see happen a lot in digital health, because everyone wants to try and use the newest thing. And that's fine, you got to try things out. But if something's not working, and you're extrapolating important information, like three levels from the actual person, because they wrote something, they haven't read it and interpret it, then you have a sentiment analysis. It's like, Do you need an AI system to call up somebody after knee surgery and figure out what they felt and how they did and have some complicated analysis, or just need a physical therapist assistant to call them and write a quick note and explain in one minute. So humans are really good at a lot of these problems. And AI doesn't need to replace all of us, that was kind of the genesis of that tweet, I was like, let's just use the right tools. And it's kind of my underlying belief on AI, adding, I've been involved with its production evolution in certain context and healthcare over the last 10 years. It shouldn't be anytime an AI is isolating people worries me. It's, you know, if, if possible, I really like use cases where AI connects people together. Like if AI was matching the right personality of the coach, the right personality, of the patient being coached. That, to me is a great use of AI, it's picking up patterns for how we're going to get along and have a more, you know, important in intimate relationships. So we have better political outcomes. That makes sense to me. So it's like, let's not use it to keep people apart. In terms of the right touch points, so there's kind of two philosophies on this. And I, I don't want to speak for all physicians, there's a lot of physicians who are happy doing what they're doing. There's a significant number that aren't happy, but they're kind of forced from circumstance or think they have no options into practicing medicine, the way we're practicing it. Now, like I told you about the content assembly line model, which which they know and the patients now is suboptimal? Right, like you know, most honestly, I mean, from a patient standpoint, healthcare system is a humiliating experience for most people, they're completely powerless. They don't know what's going on, you know, most people don't explain to them. But there are a number of physicians who are kind of waking up and seeking like, like, I'm sick of this, and I could do better and I want to have better relationships with patients are going to direct primary care, exploring new business models, and new fields, integrated medicine, functional medicine, to practice in a way that makes more sense. I think it's empower those physicians to do and I think that's the right thing. These remember all these lifestyle interventions that we Daytona health deliver, and that these physicians are most likely delivering all evidence based. We're not making up you know, this isn't acupuncture, right? This is this is stuff that we've known in the science for a long time makes a big difference to sleep, exercise, nutrition, so forth. But I so i  think I welcomed those physicians and to be part of a team where they're shored up by personal trainers, dieticians and the rest of the team that knows how to do the coaching and implement behavior change. But even if you're not one of those physicians, I still think there's a model that exists where everyone plays their strengths. And I call this model internally span wise. It's kind of our idea what we're aiming for, where instead of having a physician be the gatekeeper to the services, they are really a partner, and we're really patient centered, put the patient at the center, that no physician should be able to control access to your dietician. Because honestly, we don't know that much about nutrition most, vast majority of doctors so know the same as nutritionist, a dietician does or about exercise or training does. Remember, only 70% of cardiologists who are members of the American Heart Association report that they exercise estimates and other studies have been done show around 50% of physicians don't exercise themselves according to documents. So we're having trouble setting the change in our own behaviors and your good example, right, so we're not experts at this, we also need coaching when it comes to this. So I think that we can put the role of physicians, we've traditionally had this ego problem where we want, we want to dominate the view on health. And I think we have to realize, we're really good at very complicated things that we should be paid well, for, that's fine. But there are other members of the team that need to elevate to our level and relegate the things that we don't know, first of all, okay to say, I don't know about this. And we're gonna have all the members of our team help you with those parts, and ensure really good communication amongst those members. And that, to me is a team that wins. And that's truly patient centered. And I would say, because we're direct to consumer, we can really guarantee the patients that send in that model. Now, the MD components of something we have live yet, but that's what we're shooting for is that, that, to me seems like a primary care system that follows a person, not even a patient from a very early age to the rest of our lives. Now whether they can afford that. So that's all logistics and business. But that's the vision we're shooting for. That's a vision that seems fundamentally different from what's out there now. And that I think it's a better future for our kids, when they turn 22. Like, why aren't you hooked up with and that includes an MD that can handle the medical management, some of the decision making and falling into your 45 or 55, and can help you make better decisions. And if you need medications, you need them. And if you something bad happens, you know, the other, the other part of the healthcare systems that help you, but we should be keeping people healthy.

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Chris:

Right? Yeah, and you're talking about this difference, too, between AI and this personal touch that you get from talking to a human. And it's interesting as we talk to these care management companies that on behalf of providers are monitoring, let's say through our RPM or RTM. What they say to me or say to us, is that 80% of what they do is call each patient every day and say, Hey, did you remember to get on the scale, you please put on your cough, and just kind of nudging them, but for whatever reason that's impactful, maybe because there is this kind of intrinsic motivation that humans have, or emotional response that humans have when they're talking to a human versus getting an automated nudge, or it's just something that they know they happen to do. And I want to unpack that part a of it of like, internal and external motivational systems. And so in the internal motivation system, there is personality and mindset and skill set. But then the external motivation systems, there's kind of this, you know, culture, social pressure and incentives. How do you view these motivation systems and really impacting behavior change?

Ravi:

Yeah. So you know, motivation, motivate, don't come into the work to move into the reason to move, right. It's basically like, you know, that having a reason? I think that's great.

I mean, I mean, people say, Don't rely on motivation. And remember what they mean people have to have reasons, they have to have fundamental reason have to have thought out reasons. Now, I think what they mean when they say, you know, don't rely on motivation, rely on discipline, things like that is, you may not feel those reasons at any one time during the day. And sometimes when you're staring, you know, a Cheesecake Factory slice in front of you, those long term reasons of why you should not eat that are being grossly outweighed by massive amounts of dopamine that are ready to be fired in your, in your brain. Right. So it's like, and I understand that so it's like, that's what you need other systems. I think the division in the categorization scheme that you just described is a good one. I think it's I think it's in there are others in the behavioral science that that really tried to describe different aspects of how people behave. And health belief model transtheoretical model, you know, social cognitive theory, and how people regulate themselves, what their goals rational thinking is, on how the chain effect the environment, what stage of change? All these models are. Yeah, I think it was George Box, the mathematician talked about models generally, because you know, all models are wrong, but some are useful. So these models are useful when thinking about different things. But what I've noticed about them, is translating those like theoretical models into actual practice, like, what do I send this text message, like, what should be on that text? That person is kind of where our secret sauce or our ability really lies? And you mentioned? So I think those factors you mentioned, are part of that seemed to be in three clusters to me. So personality temperament. So what are the character traits that you have that shape your behaviors, that's really what personality and sometimes says, right? Like what other people behave in predictable ways, will other characteristics that they have that are related to those that are striving, those those behaviors? The other, the other kind of cluster of things and effective things that you mentioned? So environment, culture, literally, their zip code, who they're around all day? What are their, their external influencers? And culture is a big, very big, it's social pressures. And third, I would say is their internal belief system and their goals. And their goals are really important. How do they, what do they think about their health? What's their educational level about it? You know, what are their goals, what they want to achieve? So any behavior change system has got to address all those three things. Now, essentially, one thing, you can do that with reminders, I think those are limited. You can do it with nudges, which are much more emotional and persuasive, and kind of context sensitive. One thing I'll tell you, is something we've noticed, and I think it's something that personal trainers, people do this health coaches kind of know, from their experience of just doing this, and seeing people change. Think of people you know, in your friend circle, maybe someone's friend circle, or people you've heard about who've, like, lost that weight, who got healthy, so I'm going to do it this time. And you're like, you were skeptical, as a friend of mine, I'm not sure you know, they're always saying this, whatever. But it worked. They were able to do, and they kept it off. And you think what, what in their mindset changed and several things. But one thing I find fascinating, and I'm going to say it, and it's going to feel like a platitude, but if you really think about it, it's this idea of self care. They put themselves as a high priority. And it's funny because a lot of people who aren't healthy, just haven't thought about themselves that way. It's like do you care about your well being? Do you understand that you being healthy could affect the positively so many other people? And some of like, I've never thought about that way? They're always like, especially like the people pleaser type. So they're always trying to get, make everyone else happy. And they feel guilty, almost thinking about themselves like, Well, no, I'm fine. I'll be fine. I know, I gotta get healthy, whatever. But do you really know, that's one thing that we've noticed change in our members who have gotten healthier. It's not just that their fat mass has gone down their blood pressure that all those things come with it. It's more that their mindsets changed, you know, I am important. That's something that people who stay healthy and really healthy we've noticed kind of intrinsically either half or the development over time. And that a lot of people who aren't healthy just haven't developed that. Some aren't, but some of the barriers are environment logistics, stuff like that. But this whole kind of behavior change getting healthy. We treat the ball Daytona we treat health as a skill. It's like any other skills like racing cars, you know, what's the secret to racing a car faster on a track? It's, well, you got to break well, I got it. Sorry. Oh, you gotta take corners. Well, you got to you got to be able to navigate traffic. Well, you got to talk to your team over the radio. Well, it's like, Oh, crap, I gotta do all those things well. That's what makes a really good person, anything, it's not one thing. They brought several skills up to 80% or higher. And stay healthy is something that no one was born knowing how to do. It's just a collection of skills that we enable people to do, through affecting their environment, their mindset, understanding their goals and belief systems and tailoring to their personality.

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Chris:

Right, yeah, that makes a lot of sense. And I'm one of those people trying to go through a change again for the next for the latest time in my life. And, yeah i know, it's interesting, I think, I find personally and then with friends, I know that you've gone through the same journey. It really is about prioritizing something authentically more than whatever it is that takes you away from from that goal, right? So if it's something in the fridge, for example with me, what I, what I have is two things on the fridge. One is a picture of my family. And then the other is a picture of me, when I used to look like what I look like, right when I looked healthy, yes. And so that's just putting that I guess, emotional nudge in front of me, every time I'm about to cross that fork in the road. And I'm wondering, Is that like a founding principle of Daytona? 

Ravi:

Yeah, it's like, you know, if you look at our system, and how we, how we kind of create these nudges. Is that working, by the way, with the fridge? For you? Sorry is that working by the way?

Chris:

Yeah, no, it's definitely working. Yeah, it's definitely work. Yeah.

Ravi: 

So. So I think I think there's like a bell curve, right. So it's a Gaussian distribution, there's, there's a number of things that worked for a lot of people. So like, those things can work for a lot of people, social structure, tracking and monitoring, all these different techniques are well known work for a lot of people, and then then they need a little tweaking, then there's kind of things on the tails that that do work for someone or for others, those different techniques all are under kind of our category behavior shifting. So we think of us as like, a holder of the Bible, of all those different techniques. And we've taken those from not just the literature, but our clinical experience, but also other industries. So like, what makes someone hooked to a video game? You know, what techniques are they using? There's trophies and badges, markers of progress is constantly being able to be just challenged enough to where it's engaging with not so hard that you want to throw the controller at the screen. Right? So, you know, social play, it's, there's a Bible and there's, you know, we've constructed a framework for those, just that's not enough. Now, how do you deploy those with everybody? Well, one of those could be, you know, like, like, reminders of past performance, which I think we have in our business, which is like what you were, what you're doing, you're, you're doing breaking the impulse, impulsive thinking and like that picture, just by looking at it go Oh, stop that. That initial kind of type one thinking to just go in and kind of helps you kick in this rational thinking which right then might just be like, oh, yeah, I shouldn't want this. You're like regulating yourself. But I also we have to go down to we have to, we have to combine those behavior change techniques with two other categories of information. And this is fun to get these. One is we just the behaviors, like what, what is it you don't want someone to do? So when you're actually monitoring people, or coaching them? It's like, you need them to take specific actions. And those are pretty standard. So you like the exercise that they do, that, whatever they eat, you know, where they store food for you? In that case? It'd be like, Why do you even have that stuff in the fridge? It could be that for you, it was just not to have in the house. It's an environmental, like a choice architecture intervention, right? Like, don't even make it a choice, make the choice to get that food a lot harder, because you have to go drive to the grocery store and do those things to get it versus just being in love with the fridge. But the other one, the other category, those are pretty well described, right? Those are, that's a finite list of things. And the categories that we coach, there's only so many ways you sleep better in so many ways you can improve sleep, hygiene and so so forth. The interesting thing is the list we call calculators are portmanteau for captivating motivators. So like the underlying reasons why people want to change. If we asked you like, over a motivation interview session, like Chris, what are you trying to do all this for? What are you trying to achieve? Why do you want to avoid you why you want to put yourself in a caloric deficit or lose fat or whatever. And it's fascinating. If you really take the time to listen to people, meaningful answers come out of that session. And so it's different for everybody. Some people just want to be better examples for their, their kids, other people feel like it's holding them back from getting a promotion at work, or just the work performance. This, this list is infinite. And this is really gives you insight into the diversity of people. And that's when we say personalize. Now we've got three lists to choose from. And then we can combine those concepts to not just create reminders, but to create really powerful, meaningful nudges that are context sensitive. And that could drive you toward, okay, specific call to action, those over time, combined with the other things we talked and some of those nudges are so those behaviors are to form habits. But we find that habits don't get you there, just habits don't get you there. You do need to cultivate a intention, okay, self regulation, and rational thinking around the stuff too. So it's a combination of habits, environment, and thinking.

Chris:

Right, right. So you're saying that the right knowledge has to be made, maybe evoke some emotional response that is actually at the root cause of your personal motivation? Not necessarily what a, you know, a more superficial symptom may be, like, for example, when I lost when I got fit the first time it was so that I could go ahead and find an APA family. But no, I think I personally, the only thing that motivates me is being with my family more, right? It's very, it's, it's evolved. What, what is the right nudge, for you?

Ravi:

Yeah, for me, it's like, well, I'm gonna get coaching company, so I better get better stay in shape, right? Or get in shape and stay in shape sounds like a big motivator, Hey, Robbie, better walk the walk. It's a big, it's like, his credibility is a big thing. Okay, and also, like, you know, I have very trained knowledge into exactly it, you've seen how bad these diseases can get. So to me, it's a very visceral motivator, I don't diabetes, and heart attacks, like I don't want to be a five drugs on life Screw that. I'll run however long you want me to run the treadmill. Right. So those are really the motivators for me just because I've been viscerally exposed through my job. And what that looks like, we're a lot of people had it a little bit kind of too abstract for them. And this couple others for me to like, you know, family, of course, it's to me, like for me like a calculator. I just like being prepared. Like when things go wrong, and you got to perform. It's like what I'm mentally rough, physically fit, my brain just works better. Yeah, I'm less foggy, and much more clear and much more focused. And I think I think a lot of people can, can empathize with that. But, the sending me nudges that address those things are really important. If the right like you said, the right time I place this used to be so hard. But the good thing is, this is where technology comes into play. It's like we have many computers, with GPS location, you know, sensing ability and motion sensing ability. We know where, you know, this is all scared I sense but like, you know, we know where you are, we know where you're going. We know what you've what you're investing your time into, we know what you're watching, you know, it's when people let us in enough to where we can use those other data points. To calculate what kind of behavior you're going to have if we mean time. So this is where you can have that virtual presence, giving you that right nudge in a way that just wasn't possible 20 years ago.

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Chris:

Got it. Ya no, digital health is opening up those possibilities. Its no longer when you're in those 12 minute encounters, it is accessible all the time. So let's talk about how Daytona puts all this together, or what your master plan is for putting it together. So what is Daytona? And how did, how did it come to be? 

Ravi: 

Yeah, so. So we are a precede digital health company that's focused on health span through behavior change to the functional approach, and we use, we essentially use a team of coaches that includes health coaches, dieticians,  personal trainers, we also have executive coaches, who coaches kind of mindset and executive performance, and life coaches who really help with time management, stress management priorities, self care, and thought processes. So again, more mindset, right. And this, this team uses data about you. So your starting point, what your goals are, your health status, or your environment, the breakdown of what we talked about before, what are those techniques that would work for you, we think that the versus ones that wouldn't if some people really sensitive to competence, to competition, or others like yours too much, I don't really like to be very competitive, I'm more collaborative, those things are important for us to notice, we can apply the right ingredients. And then we use some data from the science data from you and we craft that plan to deliver virtual coaching over video and text. So we actually, we actually had our first off site visit too with one of our members, just to kick that extra motivation. Okay, yeah, they got the six month mark, and they're doing really well without the scope. So we wish we're capable of doing a loss, depending on each person. So what we usually do this is, pragmatically, first we do a discovery call with everybody who's interested. And the reason we do this and kind of separates us from the other other coaching is not everyone's ready to change, you know, just you have to be in the right mindset. You know   in the in the transtheoretical model, they call that the pre contemplative phase, think of the smoker when you're like, Hey, man, you know, it's bad for you like, yeah, you know, be ready to quit, like know, that person, don't force them, like leave him alone, let them they will come to a point where that pain has to exceed a certain threshold like yeah, this sucks. And then he was funny on this or this is socially to, you know, whatever, whatever it is, helps us to make sure that we're not forcing stuff on people who aren't at that stage of change. Second is that kind of onboarding process, and part of what we do is we actually send the digital health tools and analog tools  to each member. And it just arrives in a Brand new box in their house, okay, just take, you need a food scale, we'll send you one, you want to run your Fitbit done, you get this as part of the package, take the bears way for them to use for to use us and to get a great experience and gives us the data points, we need to help them help coach them in a guided way, especially with the wearables. The next phase is what we call calibration. It just takes this is something you can't hack. It just takes time to get to know people motivation, recessions, several hours of video meeting the team, it takes a week and a half, right just to get kind of situated and learn some sight tests and other other other testing batteries, we get more information. And at the end of that calibration, the team is like, Okay, I think we have a great starting point, we could tell you what needs to go to probably work for that we're going to use what and the behaviors we want to work on first. And then we step them through those behaviors systematically, just like going up a staircase step by step by step over the course of months. So think of like four to eight months to a year of coaching, where every week they've got their, their kind of vehicle, they figure out what worked, what didn't, why, what techniques worked, and what skills they've mastered. And then we just keep leveling up. And you know, honestly, we first usually start with sleep.

That's we found is the biggest bang for your buck to coach. Now people have real sleep disorders. And it's not just sleep hygiene. But a lot of people see big improvements, which is things like sleep hygiene, and their habits and routines around sleep. And those improvements are significant, especially the biggest bang for buck. It's like systems, small investments in time and routines can can really affect your next day and how you think and how you feel your mood and performance. And we know the effects on chronic diseases like sleep is so critical. And then we step them through nutrition, step them through exercise, and we're just layering these things on. Okay, and we do that through that video. And through those nudges and other types of messaging that we do over text and through software means. When people start getting momentum, and those results after like, wow, sleeping better, I feel I feel less tired. Yeah, I should say in the first week, Chris, people just feel relieved, honestly, because I like finally I have a system people are helping. That's like one of the first things we've noticed people just go the take a  big breath. Finally, I feel like I'm in control of this now, which is a huge stress off their brain, right. And as they start getting better than they start seeing the fat loss, the hemoglobin a1C and other metabolic markers are improving, the lipids are improving their blood pressure is improving. Everyone's noticing their friends like wow, you, you seem like you have more energy. And you see, you look younger, these are things our members get right from their peer groups. Then we start sprinkling on life coaching, executive coaching, because now they have more energy and focus and drive. And they want to feel like they're building self efficacy and grit and resilience. And they want to apply it. They want to apply it to like, well, if I could do this, I can get better at work. I can, you know, I need a raise, I need to figure out my purpose and meaning there, and how to do better? And how do I level up more? How do I get more time with my family? Where am I wasting time? What do I need to say no to? Life coaching those things. So it's really this holistic, I use holistic too much. But it really is an integrated approach that's designed to look at all areas of your life, but in a way that doesn't overwhelm you.

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Chris:

Right? Yeah, it seems like it is. Paul Graham once said, as a startup, you should do things that don't scale in order to figure out what works and what you want to scale later down the road. And it sounds like you guys are willing to try a lot of things to the end of making sure that you help a particular consumer with their behavior change. Where do you feel, you know, you are figuring out? Like, what are those things that we need to make a part of every program and then learn how to scale versus, you know, those that, hey, we tried, but they weren't as impactful? And, you know, they don't need to be systemic. 

Ravi:

Yes, very good question. So the expertise itself right now,our core expertise, like if you just took all our services, and pared it down to if you just wanted to make somebody who was more sensitive, just better, what would you include in that package? And to us, you know, so if you look at the health coaching, then they are the masters of motivation. And you look at the nutrition coaching and you look at personal training, that's what, with the tools as well. That's a pretty core team. It's like the economy seat of  the plane, but you're still gonna get to the place the same exact amount of time as the first class passengers. It's, that'll work, we created the larger more, more expensive tier, so that we can offer those extended services. We actually, in addition to that, I didn't mention this, but we actually also offer an executive assistant to that premium material. So just to help with the time, so you've got this. The reason we did that to Paul Graham's point was, we tried to reimagine what healthcare should really look like. Like if you went into the future 30 years and brought it back, this is what it would look like, just to prove that could be done, that would work. So we know that either Tier, our health coaches, the core team spends the same amount of time, it's really just the other services that are coming in or not. So not everyone needs all the rest of the stuff, our ideal situation, is to be able to use an AI approach, and other ways to drive efficiency so that we can can offer all of those to everybody, as a default, default thing at a price that makes sense. So we're aiming toward

Chris:

God, and it sounds like you guys

Ravi:

I just think think startups have certain ways to slice and dice. But think about it as two different types of risk, you have a market risk and execution risk. We don't have much market risk. In fact, if I pitch this to anybody, they're like, Well, I want that right. But like, that would be nice to my life. Now, what's the price? So that really is an execution risk? That's like, Can we do this at a price that makes sense and be profitable and have a path to profitability? And how much funding and resources would it need? What's the product market fit, you know, the marketing, all that stuff. So we're figuring those points out, we know that the core works, doesn't have profitability, we know that for what we're probably charging now that our premium works as well. But what I'd really like to do is not, not create a behavior change system for just rich people. We're trying to create a system that is affordable for the people who are suffering, which is the vast majority of the public.

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Chris:

Yeah, no, it makes a lot of sense that you could have a package that's, you know, mostly automated with some coaching, that will impact a lot of the people. And then you have the increasingly concierge model. That is, you know, very tailored and high touch, even helping manage your schedule for the things that help you change your behavior. However, none of those things on either end of the spectrum, really are paid for by insurance, and something we haven't unpacked is your business model. So can you tell our audience what your business model is? And your, you know why that's different? It opens up all these possibilities that other gosh, digital therapeutics or other programs don't have

Ravi:

So that's a , just for your head, I have time to go over to talking about this. But direct to consumer for sure. So we are, we're a little bullish about btc, etc. I know that this leaves some traditional healthcare, healthcare costs, you know, a gas like, you know, ruggedness, no, you know that what it doesn't know yet. But oh, my gosh, this is gonna hit hard. But we thought this through the reason, there's several reasons why. First, just let me take this out of the realm of theoretical and what I think and then into the realm of like, pragmatic, just what we know. We've had 40 to 50 years of this healthcare industrial complex, it has not resulted in any real, measurable prevention at scale. I mean, if you think about the diseases we're talking about, we know the interventions, we know how to deliver them. There are people who do know how to deliver them. But we talked about the health coaches that are members of that team, and we've been unable to deliver it. So what's going to change? If we go through the employer market? Are we really going to, again, try to fit a square peg into a round hole and expect success? I don't think so. I think we have to, we have to think differently, if we want different results. The direct to consumer model works for us for several reasons. One, especially after COVID People are sick and tired of being sick and tired. They have an elevated interest in their health and they care. They wouldn't be buying peloton, they wouldn't be buying totals, that they care about how they feel. What the healthcare system has gotten wrong, is that they assume that if people don't care about their diabetes metrics, that they must not care about their health. So we'll go to their employers. Well, you have to translate things like 10 year cardiac risk to what an average person cares about, our ability to get those captivators, that's what the point of that was, right? So you may not care about your 15 year risk of kidney failure. You're like, I gotta lose weight because of this thing that I really care about. I want to spend more time with my family and spend less time at work. I need coaching for, let's get to the bottom of that. That's the key to engagement is to find out people's calculators takes time to traditional healthcare system hasn't been able to do so. So that's the, that's one thing. Secondly, We don't have to wait for that admission, that system is unable to deliver you, if you agree with me on that I think we can all agree that's just hasn't empirically been. Secondly, the fundamental time to start intervening is before you get the diagnosis code. And this is the linchpin, you know, this is the entry point into the traditional healthcare model is the ICD 10 code, you have to wait for someone to diagnose you, when we know that these diseases are the result of bad processes, processes, you know, bad juju happening in your body for years, right? It's like bad eating, low exercise, lots of stress. For years, hypertension doesn't just happen. Diabetes doesn't just happen. It's the result of bad patterns for a long time. Like, let's not wait to get a diagnosis code to consider it medical, that's just kind of a weird lie that we tell ourselves. This is all medical, this is all health, sleep, exercise, nutrition, our therapies that help, there are medically evidence based therapies that help these diseases period, whether your diet, you know, that's that's we know that's true. So we'd have to wait, we make money, whether you have the disease, or diseases reversed, or you're preventing it, we're giving you value, because we're improving your longevity, improving your quality of life the whole time. And that's something that separates us out, we don't need to be the idea that a physician has to prescribe exercises is somewhat ridiculous. I don't think that's, that's a culture that we're aiming toward. I think we're trying to import a culture, we all take some responsibility into our health, of our health, which I've seen that trend, right. So over COVID , for example, I think we're at 24 to 30% of people gained like 8-9 pounds, you know, increased stress, increased depression, anxiety. Yeah, I mean, this has happened to all of us. So everyone's sick and tired of being sick and tired. They're paying an average family for something like 16 to 19,000 dollars out of pocket for health insurance. What are you getting for that insurance? Are you getting , maybe a  buffet of some apps that you may or may not use? And when you do use them when they're coming from your employer, you know, honestly, your going to a hotel, and you get that message in the hotel room that says, you know, if you don't mind, could you please save your towel, because we're trying to save the environment. And you're like, you're not trying to save the environment you're trying to save on water bills, it's okay, just be honest about it, I will help you out. Right? It almost feels like that all the time, when it comes to when the help will help thing like this prevention is coming from your employer, it's like, you guys know you're trying to get productivity out of me, he kind of just has a little contempt to it. And our whole thesis it Daytona is would you hand your credit card over? It gets real, like what you're like, oh, my gosh, I got steaks now. And it feels different. That act of vote, you know, that volitional act right there, makes it feel like I'm investing in my health, and like paying for it is the first step. But that sounds I know, it sounds weird to some people. But trust me when you know, when when you hit your credit card number over, it gets real when you when you fill out the stripe thing, right? It's something fundamentally different than just a perk that comes from your insurance. If we're really trying to make a difference here, we got to think differently, it's not wait for the diagnosis code, let's not try to ram this into a system that wasn't just wasn't designed for this to how they make their money. You know, it's, it's, it doesn't make sense. And third, let's hit on the first motivational step that people need, which is to invest in themselves, that's really the thing we're trying to change. So it makes much more sense for us, to be direct to consumer. Also, and the other thing I firmly believe is, whenever you're your end user is different from the person giving you money, the cost like the customer, I think there's less incentive to maintain quality of the product. And I think you and I have probably seen a lot of this happen over the years, where the founders didn't mean for this to happen. Nobody means for products to kind of suffer. But it's just once you only have to convince the employer, it doesn't really matter as much if the employees get an average to above average product, not an excellent product. Right. And I want to make excellent products. I want to make this so engaging, that it really is helpful that people go. I can't live without this. The past is the turnaround test, you know, so it's to do that. It's like 

Chris:

Yeah , or I can live better with this, live longer with this

Ravi:

You can't , consumers can't, can't hide a bad product.

Chris:

Right, right. Yeah, yeah, maybe that will be a great thing for the industry and outcomes. Ravi, I have a feeling I could talk to you for ages about steps our healthcare system could take to, you know, align these types of incentives and outcomes and innovations like you're working on. But I think for now, I want to thank you for your time and learnings in advice. I learned a lot about behavior hacking, and more importantly, how to think about people's motivations. And, gosh, I mean, how they can be different, the idea of Captivators and why our health system doesn't really align with, you know, helping people through their actual motivations. I love that you are trying to find that secret sauce that has the right blend of apps, humans in the loop and AI and I'm personally betting that you do so thank you for being

Ravi:

Well very much for  having us and  appreciate letting us share the vision. 

Chris:

Yes, thank you, Ravi. 

Ravi:

Thanks. Bye bye. Ok

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