The future of at-home testing and diagnostics

Chris:

Hello digital health community today I'm excited to have Ken Mayer, Founder and CEO of SAFE Health Systems that's at safehealth.me. Safe is operated in partnership with Mayo Clinic and offers a turned key digital health platform that offers provider services, diagnostics, and interrupts with many EHRs out of the box. And this allows customers to deploy really targeted apps and population health programs within weeks instead of months or years. Ken, I think it's exciting that your platform comes with all of these parts included? And I'm eager to learn more about what it can do. Welcome to the pod. Would you mind telling us briefly about yourself ?

‍Ken:

Yes, sure, first of all, thank you for having us. I really appreciate it. So actually, my background was really in entertainment, and marketing. I started when I was in college, I built a little entertainment magazine, kind of a small LA Weekly, or Village Voice. And I ended up selling that when I was 19. And I was going to school in North Carolina, and I moved up to New York City and launched a production company and about a year later ended up getting a TV show on Fox about the worst time slot on television Friday nights at 12: 30. There were about three people watching, but I got to spend my 20s struggling around the world filming bands, and you know, having a good time living in New York City. In late, I guess 99, I transitioned into tech and launched a predecessor to YouTube called GTV. And it was really a platform that allowed people to upload videos and photos, you had what we call the time buddy, because we were kind of drawing concepts from messaging. And in a wall, essentially, that we call message boards, where you can communicate with the people watching your content, but we launched it in the spring of 99. And it became so popular so quickly. We had to take it down about nine months later, after burning through $10 million in a bandwidth plow. Okay, which hadn't been commoditized yet. And the infrastructure really wasn't there. I mean, to put it in context, YouTube launched six years later, and veins about 60 million in bandwidth costs before being acquired for over a billion dollars. So not a bad return on investment. But I was like, you know, in my mid 20s, and had no idea how to raise 60 million. Yeah, it was and we ended up pivoting and selling the company. About four years later, we acquired a small company in South America that had a really sophisticated enterprise instant messaging platform. You had a lot of businesses bringing IBM to work, it was pre texting on cell phones, and you know, it, it was a big problem for the CIOs and serving, actually, HIPAA had just come out, which required encrypting personal health information that was sent out over the web. And at the time, you know, just attaching PDFs to emails, which, you know, was basically in violation of these new HIPAA regulations that the nominee did. So we had some big clients, a lot of, you know, payers, that had small field offices that were sending claims forms, just email. So we ended up selling out, I ended up selling out of that in 2006, and moved out to LA, and was playing around in the movie business and had the opportunity really to get into what became SAFE Health Systems about four years ago,

Chris:

So what inspired you to start SAFE Health?

Ken:

So originally, you know, the concept was an app that let people show their verified STD status privately on their phone. Abiding, an easy, inexpensive way to get tested and treated. You know, at a time when, you know, sort of conceptualized the app, STD rates had just hit an all time high in the US now for five consecutive years in a row. And, you know, it was basically an answer to the fact that dating apps have really made casual sex more accessible and accepted. And, you know, one of the unintended consequences of that is just these embraced STD rates. So this seemed like a real logical, simple solution to it. We launched it about five years ago, we've rebranded itself to safely and at the time, I thought it was going to be this really simple, quick thing, we'd read it and fell it off to one of the dating apps and little did I know how disjointed you know the electronic health record systems in the US were, right how sort of bifurcated and non interoperable. And this was at the very least stages of the agency pushing for interoperability standards, which ultimately fire if HR is the big EHRs. And I think now, there's pretty much unanimous sort of agreement, that that should be the file data model standard. So but that was really the key feature, right, we needed to figure out how to let people in the recent STD test results for free from anywhere. And that was sort of the initial challenge that we had to face. And, you know, what we realized is there was no silver bullet. And we now have that as a core component and enabling foundational level system within our broader platform now is integrations with all of EHRs and were part of an integrated with the largest national HIE ease to health information exchanges, we can pull patient records in, and then also push data back out to enable continuity of care. But that really was, you know, that feature that  now really developed a hardened system, the original impetus for it was really just to let people, you know, access a sort of tamper proof digital workflow for proving their STD testing status.

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Chris:

Got it. And then how did you evolve from there into more connected care at home diagnostics and, and telehealth and become a platform for others to use?

Ken:

Yeah, so you know, basically, the first challenge was, how do we let people import their recent test results to show that that was the hook, right? That was the free case and something really simple. And you have, you know, millions of people out there that are, you know, carrying around a screenshot on their phone or their test results. But if you go to Google, and you want to see something super alarming, search for a fake STD test, right, and there's dozens of sites that allow you to make just that, right. Yeah, not that people are trying to cover up chronic infections, but it's like they get caught off guard, they're going on a hookup, it's five o'clock, six o'clock at night. Yeah, that was really step one, then we said, Okay, now we need to provide an easy, inexpensive way to get tested. Right. And we want to have insurance coverage, because all insurance, you know, Medicare, Medicaid, and all the commercial payers cover STD testing, and it's fairly expensive for a six panel test, you know, the CMS rates are $350 total for like a seven, seven test panel. And you have, you know, options for at home, like everlywell, and stuff like that. But even those are 200, $250. Right, and it's all out of pocket. And none of those, you know, at-home testing solutions are currently reimbursable. So we realize that we need to requisition these tests as medically necessary by a licensed clinician, in order to cover, right. And then we also needed to have integrations with the reference labs like Quest and LabCorp. have, you know, 1000s of locations that people can book the testing, you know, in their local area, right. So the first step is we went and we forged partnerships with with quest and LabCorp, we did these very intensive sort of HL seven interfaces, with their back end systems for orders and results, and scheduling, which, you know, over a year, to not only do the HL seven integrations, but then get them certified through a very intensive process. Okay. So now we have integrations and we've got 6000 locations that people can schedule testing. Now, we needed the providers, the requisition, right, we then set out and built a national health care practice, and brought in, you know, physicians that were licensed across all 50 states. That could be used to requisition the tests and then triage the positive test cases, right? Because, right, if you want to test you now have a responsibility if it comes back positive for chlamydia, to make sure that that person gets a follow up in a timely way. And, and then ultimately, a treatment plan generally, a prescription. Right. So we built out that part and, you know, that was, you know, challenging in itself to set up a national, you know, professional medical Corporation. And so we overcame all of that. And then we said, look, it's actually not efficient to do traditional telehealth, synchronous, synchronous telehealth just to requisition tests. So we then built a system for basically creating what we call virtual consults. So questionnaires that mimic the dialogue you'd have with your doctor at the point of care, right and then the answers to those questions. shins are reviewed by a clinician that's licensed in the state where the user is. Right. And their NPI, their license is used to requisition the test as medically necessary. And then ultimately, when the results come back in, they're reviewed by, again, a clinician that's licensed in the state where the user is. And if they're positive, they follow up and triage with a prescription. But so then in order to pull all that off, we had to build what we now call the assisted care Automation Engine, which basically lets us notify the protocols for in person doctor visit, right into these virtual salts. And we also then needed to tie in with sure scripts to handle the E prescribing part. And then we needed, you know, again, the EHR integrations, we utilize that to push the records back into the patient's pain, health record, to ensure continuity of care. So so a lot of these features and functionality that we have now are on version two, or version three in terms of iterations of improving and make really started just out of necessity with this one, sort of where we thought it'd be this very, very solving

Chris:

your own problem. Yeah.

Ken:

So what we did in, in, we met their clinic, the mayo ventures team, I guess, mid 2019. and explain to them that, hey, this is what we've built so far, we want to take a step back, and actually create a platform that makes it quick and easy to create these types of population health apps right? Now, if you look at your Roman Hinze Livongo, king of the first round being called Pop health apps. And you know, they cost you know, millions of dollars and several years to get to market. If you look at overall software development, success rate trends, probably 80% that tried to make it to market failed, right? So what we did is we said, Okay, what's really needed in the market to take advantage of this new sort of semi automated virtual first model model is basically a Shopify, for digital health apps. And that's really what we built as we leverage all those core systems and integrations into the existing, you know, national healthcare. Sure. And basically abstracted it into a low to no code solution that makes it really fast and easy to stand up really specialized digital health apps that can be very easily configured or white labeled to service the specific needs of different populations or use cases. So that's, that's how it kind of evolved to where we're where we're at now.

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Chris:

Yeah, that's amazing. And it's kind of full stack and all parts included in all people included that you would need to do things like the consults and the requisitions. Who do you think your platform is? Or what use cases do you think your platform is more purpose built for today? Or to enable today?

Ken : 

Well, I mean, you know, anybody who's looking to remove friction from a clinical workflow or reduce cost, and really increase accessibility, so, you know, a hot topic lately has been, you know, health equity and people who don't have transportation and how do you move those services into the home? Another big one is you look at the telehealth industry and population health apps that have been coming out and they really hold the promise to substantially reduce cost and increase accessibility. They're missing one critical element, right? Even the 800 pound gorilla is in the telehealth space like Tella, Doc and Doctor On Demand, don't have any at home testing capabilities integrate part of our platform, you know, on one side is the sort of Shopify of digital health apps, we're very quickly stand up these kinds of turnkey custom solutions, the other side of it, SDK in orders and results interface. Okay. It enables telehealth providers to basically add Connected Home testing capabilities to their service offering, right. It feels a big gap in their service offering today, but it also really expands the scope of care scenarios that they can service where they're very limited now, right? care scenarios either don't require testing or that they can kind of get away with skipping the testing, right, which is fundamentally causing some problems in a lot of ways sort of violates antibiotic stewardship, because what's happening if you were to go and say, you know, I think I have strep throat we're you know, UTI is they will just prescribe the antibiotics without doing the testing of the commonly accepted clinical protocol at the point of care, right. So, antibiotics ship and Hippocratic Oath aside, they're also alienated from this very large revenue stream that their point of care counterparts enjoy, you know, point of care testing at $3 billion in the US last year. So there's a lot of interest from that group. And we're very close to completing that. Completing that SDK. And we're working right now, integrating the first couple of partners, which, you know, will be enabled with, with these, you know, the CD X Connected Home testing capability.

Chris:

Yeah, no, that's awesome. So I mean, that that would be a huge, unique selling proposition for your platform, right is just you greatly expand the number of scenarios that you can treat in businesses that you can build around those at home diagnostics. I'm curious on the reimbursement side, how that is handled for different flavors of at home diagnostics? Like, are they all covered? As long as you go through certain protocols? Are there gray areas? And how does your platform help adopters navigate that?

Ken:

So there is some gray area there now. And you know, one of them just taking COVID testing as an example. You look at the LI sera COVID. flu test, right? So it's a rapid molecular test, it's got a $142 CMS reimbursement rate at the point of care, right. So if you walk into your doctor, and they have a Lucia test that they bought for 50 bucks, and actually swab your nose and run it, they're at the point of care, they can get reimbursement, commercial payers or Medicare and Medicaid. No problem, right? Then if you look at same day health care, it is one of these home nursing testing services, right? The nurse comes to your door, swabs your nose, sits in her car and runs it and puts it into their EHR through her phone. That's okay, the file, right, that's a point of care test. And you just put the ratified lease of service at home. So what we're now engaged with CMS and HHS discussing is, can you utilize telehealth as the equivalent of that place of service at home? Why do you need that sort of nurse coming to the door and swabbing and sitting in your car? Isn't it the same or even better? To do it through a clinician connected, directed process? Through his CVX enabled app? And you know, the inclination there is that it's, the answer is yes. Okay. So, you know, we're working through that now. And we're working with McDermott, who's the largest, you know, healthcare attorney out there that has a consulting group called McDermott plus, that is, like a, you know, basically lobbyists as part of what they do. They were the ones that lobbied Congress to get the reimbursement mandate for the eight COVID tests a month. Later, Congress didn't feel they had the purview to require CMS to reimburse that. But then McDermott plus then went through the at home testing coalition that they organized to CMS and got CMS to approve that as well.

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Chris:

Right, got it. And then I mean, one question about, you know, everyone being able to kind of administer their own tests at home and send it off, is it just like the usability and the instructions. And I noticed on your guys' website, it looks like you've put a lot of intention behind really explaining how to do different at home deaths. Can you talk around that? And like, you know, what are some of the challenges maybe that people face? And how is an application or platform experience? Are you guys dealing with that?

Ken:

Yeah, so there's, there's a couple of answers to that. So I mean, first, taking a step back, there's really two different types of tests or three different types of tests that are supported by the platform. The first is a return to the lab test kit, right? That's you collect at home, you put it in the box, we're integrated with FedEx, you either drop it into FedEx, or FedEx will come and pick it up, it gets sent to a reference lab, and then resulted back into these sort of semi automated clinical workflows, you know, in an app powered by our platform, right, so that's the everlywell. Let's check the model. People are pretty familiar with that. We're enhancing that by connecting it into clinical workflows to enable reimbursement. The first place is that we're really pushing that out. We'll be in California, the second half of last year around STD testing. Okay, California passed a law in 2021, requiring commercial payers and CMS, or Medicaid to reimburse at home STD test kits returned to lab test kits. Okay, and that law went into effect last year. And we're now working with payers in California to fill them with solutions to actually abide by, you know, that law to implement those workflows. So finally, back to one of your questions earlier, you know, who are some of the customers or some of the use cases, we really see payers as being really beneficiary of this platform, because it reduces costs and increases civility, to routine care and chronic disease management workflows for their members, and they stand to save not, you know, millions of dollars, but but billions of dollars, you know, by semi automating some of these workflows, and moving some of these tests into the home. And for instance, you know, they're reimbursing now for an average seven, you know, test STD panel, around 350 to $400, in the waiting room, goes into a clinic or goes into their primary care physician, which can be done for 200. Using this model? So that's the return to the lab book. The second is, rapid lateral flow tests, right? And, okay, two years ago, three years ago, I wouldn't use the example of a pregnancy test, right? Now, you can use COVID, COVID antigen as the, you know, as the example. So currently, you just look at the results, right? And you could maybe tell your doctor or whatever, but they can't say that those aren't clinically reliable results, if they're conveyed by you. Right. Okay. You also can't use it for international travel, or other things like that, because they're just being conveyed. So we have a technology that we call the universal rdt. Reader. We had, it is a regulated software as a medical device. We submitted it to the FDA last year as an EUA. And at the end of the year, they asked us that it is 510 K, which is a permanent filing. The debate there with the FDA went back and forth for almost a year on the predicate devices healthy IO and scan Well, which are associated with a UTI test. They were filed as a UTI test, which by the way, have it digitally, right, where we propose to the FDA that it was in the best interest of the public good for them to approve a universe, our universal RDT reader, they can read any rapid diagnostic lateral mass. And it's basically a computer vision AI. So right, you hold your phone over, when it gets the right tilted distance, it automatically takes an image of the cassette, and then it sends it to this cloud service where a computer vision, AI machine learning model, interprets it and returns clinically reliable results, you know, again, into that automated, you know, clinical workflow. So what we propose and what we, you know, really were sort of trying to get the FDA to wrap their heads around was the idea of approving it as software as a medical device platform. Right, right, could read any test. So rather than tightly coupling our clinical study data to a particular test, we define the study protocol for validating the efficacy of the digital read for a particular test. That way, we can onboard lots of different tests quickly on it, they don't have to all be separate 510 K filings, it could be a supplement against an existing 510 K, adding the digital read that references you know, all the sort of meat and potatoes or detailed stuff on the on the AI interpretation that's embodied in our in our 510 K. So yeah, we're invited into an accelerated review process. And we expect that to be approved. Currently, we have it running in self assessment mode. So what it does, it's the same process I just described, except the addition of a button where the end user does their personal interpretation. And then all of that information is given to the provider when they review asynchronously review or, you know, with a synchronous telehealth console, they have the AI interpretation, the end user the patient's interpretation, and then a photo you know of it so that they're informed and can make clinical decisions based on

Chris:

Goddess. Got it and then the idea is once FDA approved proves that the machine learning algorithm will be able to classify the result properly without any of that kind of self identification of the result. And then that will be clinically accepted and reimbursable.

Ken:

Exactly, that's, you know, the way we designed it is, you know, we have a sort of AI training, SOP that's part of, you know, this process. As we capture about 1000 photos, the AI then makes millions of copies with slight permutations, which is a training set. And, you know, so there's ultimately a validation process for each test. And then we're now working with test developers to onboard their tests and validate them on the platform. So there'll be a growing compendium of, you know, CDMX, enabled tests, that right that are available, either, you know, through our platform with the custom apps, or available through this SDK. So the telehealth providers, and even through EHR interfaces we're working on now, point of care providers can all sort of order the CDs tests and have them result back to that encounter record in the ordering providers instance of their EHR. Right.

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Chris:

That's exciting. Yeah. How about other types of technology? So AI machine learning is a clear use case for your platform? How do you support the like, let's say remote physiological monitoring, or patient monitoring or telemedicine for improving patient outcomes.

Ken:

So we implemented a third party SDK, that's kind of like Zapier or Bluetooth interfaces for mobile health devices. And so basically, we currently support about 600 different devices. But we're now going out and actually partnering with select device manufacturers both on the IVP side, where again, we sort of enable their rapid in vitro diagnostic tests, right? You know, UTI, HIV, STD, PSA, drugs of abuse, there's a whole number of those on the IV D side. But now we're also working with actual medical device manufacturers to add things like EKG, blood ox, thermometers, scales, to support RPM models, and also to sort of enhance those virtual consoles, right? So you may have some input, your temperature, your weight. So we have that as part of the virtual consults now, and you slide a slider with your finger, you enter the information. But now you can actually say, Okay, I'm using this scale, and the scale, buttocks or, you know, blood pressure cuff, will just sit wirelessly transmitting that biometric data. We're also integrated with, you know, with the Apple Watch, and the Android based watches so that you can send biometric data from, you know, those wearables into these clinical workflows.

Chris:

That's great, because it makes the console more convenient for everyone and more accurate for everyone. And then I think eventually, those observations of the RPM will be reimbursable,

Ken:

as well. And those are now I mean, the whole point of patient monitoring is it's remote. So those are all very solidified. And there are some tests, like I said, with California, they just passed a law with the STD return to lab. We have been getting reimbursements. Several of our customers that have kind of white labeled solutions have been getting reimbursed at the $34 rate for the rapid molecular tests. Right. Okay. And what we tend to call it is, I mean, COVID confuses things a little bit with this OTC designation. So, you know, over the counter, I mean, we see these tests being sold over the counter, but you can only use them in conjunction with a clinician connected, directed process, through a CD X enable that, again, one that's created on our platform, using kind of the shop five digital health app functionality or, you know, through TelaDoc, or Dr. on demand, share ABC or sinais app that's powered by Amazon, their telehealth app. So you know, the idea is that if you want to utilize the results of the test, to get a treatment plan, presumably a prescription right and you want it to be reversed, you'll have to use it and scan it and use it as part of one of these workflows. We were awarded a multi year contract from HHS last year, okay. Basically help them in the federal government define standards and set up infrastructure. Sure, to enable a connected home testing system as part of the national health care infrastructure. And part of that is an open screen. So our platform and setting up a reference instance, for HHS, you know, that will basically enable any application developer to add CVX capabilities, you know, to their applications. And it's all based on web 3.0 technologies and micro services open API. So that, you know, you can really enable not only applications to register themselves, and enable communication between end users say, a patient and a provider, but also machines and machine communication, which is where things really interesting and what the ecosystem, you know, the current healthcare ecosystem is lacking is that sort of coordination layer that acts as kind of connective tissue.

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Chris:

Right? That's great. So you guys have a platform now, and you're open sourcing some of these components, and really helping guide HHS, right, and allowing other people to kind of build up their own solutions and platforms. But of course, you guys will always be kind of like the AWS managed version of all of these things, too.

Ken:

Okay. I mean, that's really the point. I mean, we can come in and accelerate it, but we don't want to just keep this to ourselves. I mean, it's important that, you know, in order to facilitate all the advantages of, you know, connected home care, not only in the cost savings, but again, accessibility and health equity, and absolutely, the reduction in costs is also going to allow for the money that is allocated to a particular condition, right, like, you know, even take, like, you know, prostate cancer or cervical cancer, right. And soon, we'll live in a world where it'll be the norm to do a genetic screening, right? And you'll know, and probably not so distant future where you feel irresponsible as a parent, not to have a genetic screening for your newborn baby, when they get their vaccinations, right. Like, why wouldn't you want to know, their, their, you know, their risks? Yeah, biological data, right, and the risks that they have, and if you know that they've got a gene mutation that could be a positive predisposition to a certain type of cancer. And you know that catching that cancer early is going to make it much more treatable, right, you're going to want to monitor it frequently, right? But getting to the hospital for those tests right now, and having to go to the point of care to do them, really doesn't allow for that. But if you could do 50 tests for the price of what it cost a payer to do just one now, and the payer is gonna be like, Fine, you know, go ahead and do 30, that's still a cost savings for us. And it's better for us, because we'll be able to catch, you know, the onset of these diseases earlier, which makes them not only more treatable, which is obviously good for the patient, but also less expensive to treat, which is good for the payer. Yeah. No, I think you're right, shift in the thinking of how we approach disease monitoring, and certainly cut a lot of fat off of these just Ultra common routine care and chronic disease management scenarios that are just handled in a way that's inefficient today.

Chris:

Yeah, no, that's, that's really powerful. I think the cost of the system, that's a huge impact. And then also, on the consumer side, I don't know how many times myself included, I've been stopped from getting a you know, a consultation, or a diagnostic because I just don't want to take that time to go in to a point of care or have a, a less comfortable conversation with someone I don't really know, you know, in a health system. And I think guys, like the STD case, for example, that's very sensitive. And I'm sure so many people are blocked from getting tested, just because they have their own stigma for going in and talking to a person about that potential. So I think, yeah, you hit the nail on the head as far as, okay, macro level, it's the cost, but for the consumer, really that accessibility and convenience, and willingness, right to go ahead and get the care checkups that they need.

Ken:

It's true. It's one of the, I think, important things that we've done with the platform, we talk a lot about the CDMX, you know, the connected diagnostics system. And that is a fundamental thing. Like we need to enable connected care with diagnostics in the home. It's integrated and actually powered by the clinical workflow. And we're starting there, we were really focused on it. But I think the idea of of care automation and applying workflow engine decision engine technology as we've done to these care workflows is something that the time has come right I mean, these technologies are very baked at this point, they've been applied incredibly successfully to supply chain management, manufacturing, dealing with incredibly complex things. I mean, imagine all the components inside this iPhone, right? All needed to be shipped to a factory, and all needed to be put together in a certain way. And then billions of these needed to be moved all around the world and everything tracked and, you know, yeah, and now imagine applying the same technology that drives that from like, you know, ServiceNow, for instance, right. And it recently brought on the former Chief Architect at ServiceNow, who is now our chief architect. And that says a lot because it shows where we're focused. You imagine all that complexity that I just meant, and how robust that those technologies are now, looking at applying that to the protocol for prostate cancer screening, right. And it just used this one example, there's, you know, a guy over 50 has his primary care, you know, annual checkup, and he has a high PSA level, that's a prostate cancer mark, prostate cancer, energy, slow moving cancer, and the protocol for that, assuming it's not off the charts high is to monitor it, right, twice a year screen for the rest of their life. Currently, that guy at 50 years old for the next 40 years, has to take off twice a year and go into the Medicare to get a test that costs around 400 bucks that payers are reimbursed, right? There's a lateral flow PSA test that costs about $2.50. We're working with that manufacturer and that test developer, right. With our platform, you can establish what we call a care automation protocol. That would be authored by whoever the world expert urologist in prostate cancer is, right. And what it defines is basically each step in a clinical protocol. So with this one, it's okay to monitor this patient by doing a PSA screening twice a year. So every January 15, and July 15, a PSA test is automatically dropped, shipped from an integrated three PL. The patient then gets annoyed with text reminders until they take the test, take the 10 minutes to take the test and scan it. If the levels are normal, the process just continues. If they cross a pre programmed threshold that the urologist authored into that care automation protocol, it automatically sets up an appointment for a biopsy. Okay, I mean, it can talk to any urologist, they'll tell you after year two or three, there's almost a 100% drop off in adherence to coming in that second time a year to get tested. And you know, the difference of coming in that that you know that second time could be the difference of that prostate cancer, metastasizing and spreading into your bones or your lymph nodes, and going from something that was incredibly treatable, right, just pull out your prostate to now oh my god, I'm now getting chemo and have a risk of you know, very short lifespan, right? That process that I just mentioned, can be done for about a quarter of the current price. And there's no burnout from the provider, the providers not having to deal with mundane stuff that algorithms are much better suited to handle.

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Chris:

Got it? Got it, and then catch me and it seems like you know your vision of this type of, you know, workflow and automation and at home diagnostics. You're very well positioned in this market. What is your commercial strategy?

Ken:

So our commercial strategy is essentially to partner with large players in the industry and provide pest solutions so platform as a service solutions and the way we architected the platform is we can provide someone like Cardinal right it's okay biggest med surg and pharmaceutical distributors. We actually recently brought on the retired CEO, Mike Kaufman of Cardinal, who is now on our board of directors. Okay, so a company like Cardinal that's already servicing, you know, 1000s and 1000s of, you know, private practices, independent pharmacies, could basically we could provide them a solution that, you know, say a virtual pharmacy solution, right, that would allow independent pharmacies to have hybrid virtual physical type care scenarios and through deregulation, pharmacists can now requisition tests and even prescribe a number of different medications at the same time, under a barrage from Population Health and digital enabled competitors right capsule. True feel nervous Roman hymns. I mean, they're all like eating away at the independent pharmacist because if you're getting on your IDI medication, right, through Hinz, you're not going into your local pharmacy where you used to go pick it up, right, that's a lost passion, a loss script for them. So, you know, there is a real demand for that. So rather than us having to go out to 10,000, pharmacies, we'd enable an entity like Cardinal, right, that already has those relationships is already selling products and services, in some cases already SAS software, they would then go enabled by a past solution platform as a service solution we give them to then go offer a SaaS solution to their existing candidate. And, you know, another example is with payers, we were in discussions with a number of payers, around basically solving pain points or areas of cost reduction, that that's possible by, you know, either semi automating or moving the care scenario into the home. So we see payers, as, you know, beneficiaries of the platform. You know, another is employers out there, there's more and more self insured employers. And, you know, for the first time you really have entrepreneurial minded people that have a say, in the plan design, right, because when you say self insured employers, it's not like they're actually handling the insurance, it's your typical insurance providers like United or Aetna, or actually behind the scenes doing the actuary tables, and the actual insurance, it's just the company pays into that plan. And for that they have a little bit of, you know, say in the design of the plant, and, you know, their objective isn't just provide the care services at the lowest cost. So the actuary table, margins work out, right. They also have the added, you know, challenge or desire, not only to reduce costs, but to reduce out of work time when an employee or a family member gets sick, or is dealing with a chronic infection. Right. So now they're looking at how we have preventative care. Now, not only treat this UTI, but do it in 30 minutes, as opposed to having to take a half a day off work? Or when this employee who's a single moms kid gets strep throat for the third time in third grade? You know, how do we have fun with that home without having to take off work, drive across town, sit in a germ infested waiting room, potentially getting sick herself, all just to deal with our kids, you know, strep throat, right? So we really see self insured employers as being big drivers of innovation. Because ultimately, they'll prove out these cost savings and efficiencies, and have the discretion and really the wherewithal and desire to try these new things. And then that ultimately proved to the commercial players, hey, let's integrate these concepts into our commercial plans, right. And then ultimately, CMS to probably be the slowest adopter, just, you know, being the government, you know, we'll have a lot of sort of proof points and market data to either encourage or almost forced them, you know, through Congress to adopt, you know, more efficient methodologies like that.

Chris:

Right. That's exciting, ya know, and I guess that's a big benefit of being a platform, or, as you mentioned, like a platform as a service. Normally, if a startup was saying, Oh, well, we can be used by providers or payers, or someone targeting independent pharmacies or governments, right? You would tell them, Oh, well, you're crazy to target all of those. But if you have a platform that really has all of those building blocks, that authentically can be built up to serve all of those cases and packages as a platform not as SAS, then then you can't do that. Right. And it actually makes sense to

Ken:

It's funny because you hit the nail on the head. We went out talking to, you know, your typical Silicon Valley, you know, funds about about the, we pretty much uniformly got, you're not focused and what was funny is, you know, and I respect a lot of these people that told us that we got nose, we luckily we, we did $102 million in revenue. Last year, we generated about $35 million in gross profit. So we just kind of, you know, use non dilutive, you know, profit to basically which we pretty much right investments entirely into Product Development and Engineering because at the end of the day, we are a computer science, you know, platform company, and so, but we, you know, we got that feedback, including from very, very smart people that just didn't get what you just, you know, very quickly understood in that They're like, You need to focus on this condition or this area, this customer category. And that's always why we've built something incredibly flexible, that with, you know, now, hundreds and hundreds of settings, in a matter of hours can be configured just as easily to deal with breast cancer recovery as toenail fungus, right, we're a solution for payers as a university, right? independent pharmacy or private, you know, physician practice, right. And there really is no difference to us in terms of how we architected the platform. And, and that's why we see, you know, the opportunities. And up here at the surface, we really see ourselves being infrastructure, you know, layers, that's why we're now open sourcing, and making SDKs. So that you don't even have to use applications built on our platform, we can give it to TelaDoc, and to knirps, and Roman hymns lungo. You know, it is integrated into EHRs. So the Medicare providers can order Connected Home tests, the same way they order, you know, tests from Quest and LabCorp. Now, right, that is just instead of being results back from a lab information system at a centralized lab, and LIS, it's just being returned back from your phone.

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Chris:

Yep. Got it. Yeah. And it's interesting that you got that feedback from the, you know, the valley and the sandhill types of investors. But what I just learned about is your journey as an entrepreneur where, you know, actually, you didn't start with the platform as a service, you started with your own problem around STDs, and you ended up building into a SAS and then into a flexible platform. Right? So you didn't start with this grand notion that could, you know, only be achieved if people bought it, like you solved your own problem, you realize that he could solve many other problems and put the platform around that. I last question for you, Ken, is, I mean, I think your entrepreneurial journey is fascinating, and all of the different, you know, companies and pivots. And building blocks that you've built to this point have been very successful. Do you have any advice for other entrepreneurs in digital out there? Or otherwise?

Ken:

I mean, it's funny that we've been discussing this a lot, I have a partner who is worth pointing out. He is, you know, officially a co-founder, because he came on about a year or so after we founded the company, but I look at him that way. And I put them on the board. It's our CTO, Denise, you know, who I constantly have people, oh, you're a visionary. And it may be so on the business side. But I mean, he's really the technical visionary. That's, it's made this a reality. And it has taken, you know, since that first proof of concept, single app, we had this sort of build and destroy iterative sort of model, we built the first prototype of that, by the time it got ready to launch and we launched it, the code was so bloated, because we were figuring out how to build it as we as we went along, right, and you don't want to do that, the worst thing you can do with the software. So we had two versions of that just in the proof of concept that when it was just an app, not a platform for creating apps, and we're now microservice by microservice rolling out really an iteration of the actual platform version of it. And it's been really interesting, because he and I both approach things differently in one way and the way we think about things, I also have a passion for abstracting problems. And, you know, I really look up to Ilan and say what you will about him and this and that, but that guy, his heart is in the right place. And, you know, to bring it, you know, back to, to your question. I think he's one of the two of the main components of his success. One is he breaks things down to first principle, as he calls it. And that's what I was just sort of getting to within me, and how him and I think and how we've approached building this level of flexibility, which, you know, most people can't, you know, comprehend, let alone figure out how to actually architect and then code and, and bring to life is because we take every challenge, and we break it down. What is its first principle? What is the fundamental of this problem? And I think a lot of entrepreneurs and, you know, certainly software engineers, and architects look at it at the problem level, right? Or maybe even the causality of the problem. But getting into the root causality, that might cause the thing that causes the problem, like you really have to break it down to its most fundamental building block. I mean, kind of what they're doing in CERN, trying to figure out what is the most fundamental building block of a subatomic particle, right? It's like, everything's made of atoms. Well, what's inside of that nucleus? What's inside of that? What's inside of that? What's inside of that? And I think that's kind of important sort of advice in it. It's across industries, it really doesn't matter what you're working on. But if you don't know what those foundation principles are, you're not going to build the right the right thing, right, you're going to build on a level above where you should be thinking you're starting, caught. And then finally, it's really just, again, back to something that I think Elon personifies, and that is having your guideposts like having your objective, your mission, what it is that you're trying to accomplish, always clear, and insightful. And if you just use that as your sort of barometer, as you're just, you know, being hit with crazy winds and snows and machine gunfire and mortars and all the stuff that it takes to build a company, you always have this sort of guiding light to keep you going in the right direction, because it's easy to lose track when you're in the jungle, and you're taking machine gun fire and mortars and right, that's telling you this, your boards telling you that customers yelling at you for that and your friends suggesting this and you know, it's hard to not lose sight of where you're going, where to get pushed off course. And because it's a long journey, every time you're pushed off course a little bit. You have to be correct, right. And you're taking a lot more energy and capital to do it. So the more you can follow a straight line towards what your objective is. I think that that's really important. And I think having a mission that's bigger than your commercial outcome that you're looking for, really helps to effectuate or operationalize that.

Chris:

Yeah, no, that's awesome. I think that's great advice and, you know, I can tell you, you broke it down into first principles and then had your mission and when other people told you that mission was too big, you said, No, it's not. And I'm going to show you and you've done that. And that's awesome. So Ken, it's been a pleasure having you on the pod. I'm a huge fan of what you're doing, just learned a whole lot more of what you're doing, and really agree that platforms like yours are key to making quality care more accessible, and we, you know, and to do that we have to bring more care to the patients. Thank you for coming on.

Ken:

All right. Thanks. Have a good day. You too.

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