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Happy Health Develops a Wearable that Can Drive Healthcare Decision Making · Vanguards of Healthcare by Bloomberg Intelligence

• 0:20
  Speaker 1: Welcome to another exciting episode of the Vanguards of Healthcare series.
• 0:23
  Speaker 1: My name is Matt Henriksen, the Medical Technology Analyst at
• 0:26
  Speaker 1: Bloomberg Intelligence, which is the in-house equity research platform of
• 0:29
  Speaker 1: Bloomberg LP. We are pleased to have with us today
• 0:32
  Speaker 1: Dustin Freckleton. founder and CEO of Happy Health, a privately
• 0:36
  Speaker 1: held medical device company that is innovating AI-powered wearable health
• 0:40
  Speaker 1: technology with its Happy Ring platform. Dustin, thank you for
• 0:44
  Speaker 1: joining us today.
• 0:45
  Speaker 2: Thanks for having me, Matt.
• 0:46
  Speaker 1: So we're recording this just a few weeks after the
• 0:50
  Speaker 1: FDA approval that you got for the Happy Ring for
• 0:53
  Speaker 1: the blood pressure indication. So I'm just curious to jump
• 0:56
  Speaker 1: right in. How have the last few weeks been?
• 0:59
  Speaker 2: Honestly, it's been chaos, good chaos.
• 1:01
  Speaker 3: We've had just an incredible outpouring of interest and support
• 1:04
  Speaker 3: from industry, including manufacturers, insurers, hospital systems, et cetera.
• 1:11
  Speaker 2: It's a really exciting moment for healthcare.
• 1:13
  Speaker 1: And I just had to carry, because now as the
• 1:15
  Speaker 1: CEO head on, how have you been able to juggle
• 1:17
  Speaker 1: all those different requests? How do you prioritize everything?
• 1:20
  Speaker 3: My wife would probably say not very well. Balance is,
• 1:25
  Speaker 3: I think, all in the eyes of the beholder. But
• 1:27
  Speaker 3: what we have the opportunity to do now at Happy
• 1:30
  Speaker 3: Health is really deliver on the promise that healthcare has
• 1:34
  Speaker 3: made for a long time, which is moving care out
• 1:37
  Speaker 3: of the hospital system and into the home.
• 1:39
  Speaker 2: And there's a lot of aspects to that.
• 1:41
  Speaker 3: We've built an incredible platform that includes a technology layer,
• 1:45
  Speaker 3: a analysis layer, a services layer, et cetera. And all
• 1:49
  Speaker 3: that really has to be combined in order to be
• 1:52
  Speaker 3: able to deliver a comprehensive and seamless healthcare experience at home.
• 1:56
  Speaker 2: And that's what we're doing at Happy.
• 1:58
  Speaker 1: Well, I think that's like the holy grail that we're
• 2:00
  Speaker 1: looking at is how to connect the consumable side of
• 2:04
  Speaker 1: the wearables into the kind of healthcare decision-making process. And
• 2:09
  Speaker 1: so kind of, you know, thinking about some of the
• 2:11
  Speaker 1: other larger names out there, the Auras out there, the
• 2:13
  Speaker 1: Woops out there, what's your view of the current state
• 2:17
  Speaker 1: of their technology? And, you know, what is the potential
• 2:21
  Speaker 1: hurdle for them to get to that next level? Yeah,
• 2:24
  Speaker 1: I can definitely comment on the kind of general market
• 2:27
  Speaker 1: as a whole. So we have lived in a world
• 2:30
  Speaker 1: where wearables have kind of permeated every aspect of our
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  Speaker 1: kind of daily experience, right? As you mentioned, we all
• 2:37
  Speaker 1: have a device now that's measuring sleep or activity or
• 2:40
  Speaker 1: some other aspect of our daily lifestyle and or health experience.
• 2:45
  Speaker 1: But historically, what we've had is these kind of two
• 2:48
  Speaker 1: awkwardly side-by-side processes industries. You have the consumer wearables on
• 2:54
  Speaker 1: one side that have great form factors, they have great
• 2:57
  Speaker 1: user experience, good material selection, good packaging, all the things
• 3:01
  Speaker 1: that really make something sticky and engaging in your daily life.
• 3:04
  Speaker 1: But unfortunately, the data quality that comes from these devices
• 3:07
  Speaker 1: has historically been quite limited. On the other side, you
• 3:10
  Speaker 1: have medical devices that are sort of the inverse of that.
• 3:13
  Speaker 1: They have incredible accuracy, they're clinically validated, they're FDA cleared,
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  Speaker 1: they can actually drive decision making. but they're so clunky
• 3:22
  Speaker 1: and difficult to use. You need user manuals to figure
• 3:25
  Speaker 1: out how to turn them on and charge them that
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  Speaker 1: people just don't engage with them in their daily life.
• 3:30
  Speaker 1: And so it turns out that it doesn't matter how
• 3:32
  Speaker 1: accurate a device is. If the data quality is high,
• 3:38
  Speaker 1: but the usability is low, people aren't going to use it.
• 3:41
  Speaker 1: And if it's sitting on the nightstand rather than on
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  Speaker 1: the body, it's not creating value. Conversely, it doesn't matter
• 3:46
  Speaker 1: how popular a device is and how often you're wearing it.
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  Speaker 2: If the data quality.
• 3:50
  Speaker 3: Is low, then the ability to actually drive clinical decision-making
• 3:54
  Speaker 3: and health outcomes is also very low. And so we
• 3:57
  Speaker 3: wanted to be kind of the catalyst of collision between
• 4:00
  Speaker 3: these two worlds, bringing wearable devices with all of their
• 4:03
  Speaker 3: simplicity and the delightfulness of the experience with medical devices,
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  Speaker 3: with their accuracy and their ability to actually drive better
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  Speaker 3: health outcomes. And I think that's kind of the world
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  Speaker 3: that we live in today. We have these wearable devices
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  Speaker 3: that have proven that people care about their health and well-being,
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  Speaker 3: devices that prove that people care about sleep and they
• 4:23
  Speaker 3: care about being able to have information to make better decisions.
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  Speaker 3: And now we have the opportunity to combine that with
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  Speaker 3: a level of precision and accuracy that moves beyond just
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  Speaker 3: kind of data and insight level understanding to real action
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  Speaker 3: and outcomes.
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  Speaker 1: It sounds like the no data collection from the medical
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  Speaker 1: grade devices that are not being worn is just as
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  Speaker 1: bad as the low data quality. And I think that
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  Speaker 1: term is very interesting, data quality. For those kind of
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  Speaker 1: more consumable technologies out there, what is it that is
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  Speaker 1: making the data quality not as robust as it potentially
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  Speaker 1: could be? So I think it comes down to what
• 5:04
  Speaker 1: your focus is. If your focus is on marketing and
• 5:07
  Speaker 1: brand appeal, you're going to index on and optimize for
• 5:10
  Speaker 1: a certain set of features and conditions. Whereas if your
• 5:13
  Speaker 1: focus is on healthcare, there are other things that are
• 5:15
  Speaker 1: going to matter more to you. From our perspective, the
• 5:19
  Speaker 1: Happy Ring measures 2.8 million data points every single night
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  Speaker 1: on every single person. You compare that to a traditional
• 5:27
  Speaker 1: consumer wearable that may be outputting 5 to 10 measurements
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  Speaker 1: on kind of an average basis every night. And it
• 5:34
  Speaker 1: turns out that the real information lives in between those averages.
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  Speaker 1: If all that you have is a single value, it's
• 5:41
  Speaker 1: kind of like if I.
• 5:43
  Speaker 2: gave you a.
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  Speaker 3: Single frame of an entire movie and said, tell me
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  Speaker 3: who the characters are and tell me what the plot
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  Speaker 3: line is and what is happening, you'd be able to
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  Speaker 3: tell me certain aspects from that single frame, but the
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  Speaker 3: context of the picture would be really lost. And healthcare
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  Speaker 3: is similar. Healthcare disease is something that develops over time.
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  Speaker 3: It's continuously progressing. And if all that we have is
• 6:07
  Speaker 3: a snapshot of a person's health, then we're really missing
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  Speaker 3: the underlying context. And that's the difference between Happy and
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  Speaker 3: what some of the other consumer devices on the market
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  Speaker 3: are offering.
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  Speaker 1: Well, it's starting to sound a lot like what continuous
• 6:23
  Speaker 1: glucose monitors did for monitoring glucose levels for diabetic patients
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  Speaker 1: versus the traditional finger stick when you went from maybe
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  Speaker 1: five or six readings a day for those most... you know,
• 6:35
  Speaker 1: the most disciplined patients to, you know, 288 readings per day.
• 6:39
  Speaker 1: It sounds like that type of approach. So you saw
• 6:43
  Speaker 1: this opportunity here. So what was your path from seeing
• 6:47
  Speaker 1: this opportunity and what was your kind of prior experiences
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  Speaker 1: to help you essentially found Happy Health?
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  Speaker 3: So my personal background is I'm a physician. I did
• 6:59
  Speaker 3: medical school at the University of Texas at Houston. And
• 7:02
  Speaker 3: I had a somewhat atypical experience experience in that as
• 7:06
  Speaker 3: a second year medical student, I suffered an embolic stroke.
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  Speaker 2: I was 24 years old. I was healthy.
• 7:12
  Speaker 3: I had no reason to have a stroke, but I did.
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  Speaker 3: And it left me paralyzed on one half of my
• 7:18
  Speaker 3: body for several months.
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  Speaker 2: And so my.
• 7:21
  Speaker 3: Medical school experience was a combination of learning how to
• 7:25
  Speaker 3: both deliver health care and how to receive health care.
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  Speaker 3: And I remember as I was sitting there in that
• 7:31
  Speaker 3: hospital bed trying to figure out what happened and what
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  Speaker 3: did this mean for my future, the thing that was
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  Speaker 3: probably most frustrating to me is that I had devoted
• 7:40
  Speaker 3: my life to understanding everything that I could about the
• 7:44
  Speaker 3: human body, about health states, about disease states. And I
• 7:48
  Speaker 3: knew more at that time than probably 99% of humanity
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  Speaker 3: if you go back to the beginning of time. And
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  Speaker 3: it was frustrating that something could have been happening inside
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  Speaker 3: of me that despite all of my understanding and knowledge,
• 8:03
  Speaker 3: was completely invisible to me. It had not yet risen
• 8:07
  Speaker 3: to the level of my conscious awareness. And so as
• 8:10
  Speaker 3: I went through the difficult recovery process of both keeping
• 8:14
  Speaker 3: up with my colleagues in my studies and literally learning
• 8:18
  Speaker 3: how to walk again, I realized that there was an
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  Speaker 3: opportunity to take healthcare out of a reactive mode, which
• 8:26
  Speaker 3: is somebody presents to a hospital, they have symptoms, some catastrophic,
• 8:29
  Speaker 3: maybe life event has happened. Now, how do we circle
• 8:32
  Speaker 3: the wagons and help those individuals to be able to
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  Speaker 3: recover and live their best life afterwards? How do we
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  Speaker 3: move from that reactive to a more proactive approach? How
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  Speaker 3: do we help people to be able to surface those
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  Speaker 3: things that are below conscious awareness, bring them to the
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  Speaker 3: level of awareness that so that they can act when
• 8:50
  Speaker 3: it's just a maybe urgency rather than an emergency. And
• 8:54
  Speaker 3: it was that experience going through that that helped me
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  Speaker 3: understand that if I could do that and solve that
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  Speaker 3: problem for myself, that there were tens and hundreds of
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  Speaker 3: millions of people in the United States alone, let alone worldwide,
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  Speaker 3: that were similarly suffering from medical conditions that we had
• 9:11
  Speaker 3: the opportunity to make a real difference in.
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  Speaker 1: Yeah, that's a common theme throughout a lot of these
• 9:16
  Speaker 1: episodes is how to be proactive versus reactive because at
• 9:20
  Speaker 1: that point, there could have been something that could have
• 9:23
  Speaker 1: prevented the stroke and amazing recovery because I did not
• 9:27
  Speaker 1: know that. And when you walked into the studio, you
• 9:31
  Speaker 1: seemed like someone who never had a stroke. So that's
• 9:34
  Speaker 1: an amazing recovery process there. How do we translate that?
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  Speaker 1: Looking for the proactive to how you envisioned the happy
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  Speaker 1: ring for combining more technology to improve the data quality,
• 9:52
  Speaker 1: as well as combining how to make actionable decisions within
• 9:58
  Speaker 1: the healthcare system offline. of that data?
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  Speaker 3: What we realized early on was that the real value
• 10:05
  Speaker 3: was in the data.
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  Speaker 2: Data is the gold.
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  Speaker 3: The sensors or the now AI models or the other
• 10:12
  Speaker 3: things that we use to sort of instrument that are
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  Speaker 3: really just the tools to access the gold. And so
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  Speaker 3: from the very beginning, our entire design thesis was how
• 10:22
  Speaker 3: do we collect the most accurate and comprehensive data on
• 10:26
  Speaker 3: the human body in real time? And how do we
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  Speaker 3: do it in the real world, in the lives that
• 10:32
  Speaker 3: people are living on a day-to-day basis? How do we
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  Speaker 3: ensure that that data is comprehensive in the fact that
• 10:41
  Speaker 3: it measures brain and body metrics across multiple different systems simultaneously?
• 10:46
  Speaker 3: Because Health is a complex issue. It cannot be boiled
• 10:52
  Speaker 3: down to just a single measurement or a single variable.
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  Speaker 3: You really have to look at everything in totality, both
• 10:58
  Speaker 3: what's happening objectively as well as what's happening subjectively in
• 11:02
  Speaker 3: order to be able to deliver optimal care. And we
• 11:06
  Speaker 3: wanted to be able to reduce that down into a
• 11:09
  Speaker 3: technology that could be miniaturized and put into a wearable
• 11:12
  Speaker 3: device that when somebody put it on their body, it
• 11:15
  Speaker 3: fell into the background and they almost forgot that it
• 11:17
  Speaker 3: was there. And we knew that if we could measure
• 11:19
  Speaker 3: that quality of data consistently over time, that we would
• 11:24
  Speaker 3: be able to see things that other devices were not
• 11:28
  Speaker 3: able to see. And we would be able to identify
• 11:31
  Speaker 3: states much sooner than what would otherwise require a presentation
• 11:36
  Speaker 3: to the hospital in order to do. And so with
• 11:39
  Speaker 3: our three FDA clearances, we have a cleared hardware stack,
• 11:44
  Speaker 3: and multiple clearances for metrics that are related to both
• 11:51
  Speaker 3: individual values, such as heart rate or pulse oximetry, but
• 11:56
  Speaker 3: on top of that, then the ability to diagnose conditions
• 12:00
  Speaker 3: like sleep apnea, and now the ability to measure and
• 12:04
  Speaker 3: monitor blood pressure continuously at home. And so with those
• 12:08
  Speaker 3: all combined together, it gives us a window of insight
• 12:11
  Speaker 3: into what's happening in a person's health condition, so that
• 12:15
  Speaker 3: we can see those much sooner and intervene when it counts.
• 12:20
  Speaker 2: That's interesting.
• 12:21
  Speaker 1: I kind of want to take a second to kind
• 12:23
  Speaker 1: of go through those different layers of FDA approvals, because
• 12:27
  Speaker 1: you talked about the hardware, and we'll get into that.
• 12:29
  Speaker 1: It looks like you're wearing one right now.
• 12:30
  Speaker 3: I am.
• 12:31
  Speaker 1: And too bad this is an audio only, but we'll
• 12:33
  Speaker 1: dive deep into kind of the, because it does look
• 12:35
  Speaker 1: like a standard or a whoop ring out there. But
• 12:40
  Speaker 1: you talked about the diagnosis and the, was it the
• 12:44
  Speaker 1: matching component of those FDA approvals? What's, that sounds to
• 12:50
  Speaker 1: be the secret sauce in there, because it sounds like
• 12:52
  Speaker 1: the hardware is the heart, the ring's the ring, and
• 12:54
  Speaker 1: maybe there's more features in that ring than some of
• 12:56
  Speaker 1: the competition. But having those other FDA approvals sounds to
• 13:00
  Speaker 1: be like the secret sauce to getting it all together.
• 13:02
  Speaker 1: Am I thinking about that the right way? And if so,
• 13:05
  Speaker 1: what exactly are within those FDA approvals that allow that
• 13:08
  Speaker 1: to happen?
• 13:09
  Speaker 3: Yeah, so having those FDA approvals definitely puts us in
• 13:12
  Speaker 3: a category of our own. So we are the only
• 13:16
  Speaker 3: FDA cleared smart ring on the market. And what that
• 13:19
  Speaker 3: means is that we have to go through rigorous testing,
• 13:22
  Speaker 3: clinical validation against gold standard reference devices to be able
• 13:27
  Speaker 3: to show that our measurements are accurate to what you
• 13:31
  Speaker 3: would get in a hospital setting. And importantly, when you
• 13:34
  Speaker 3: go through clinical validation, You not only you can't be
• 13:39
  Speaker 3: selective on the population that you're testing on. It's well
• 13:43
  Speaker 3: known that you can tip the scales in your favor
• 13:47
  Speaker 3: if you want to prove an outcome just based off
• 13:49
  Speaker 3: of how you are recruiting subjects for a study. Right. Well,
• 13:53
  Speaker 3: when you go through the FDA, they look at what
• 13:55
  Speaker 3: is your intended use and you have to recruit for
• 13:59
  Speaker 3: that intended use. So that means diversity in your demographic profile,
• 14:04
  Speaker 3: in your health condition profile, et cetera, basically so that
• 14:08
  Speaker 3: anybody who puts on the device, you know that it's
• 14:11
  Speaker 3: going to work for them. And so that is a
• 14:14
  Speaker 3: big difference between what we have at Happy and what
• 14:17
  Speaker 3: others in the more kind of consumer space have is
• 14:20
  Speaker 3: that rigor in testing and validation.
• 14:23
  Speaker 2: Okay.
• 14:24
  Speaker 1: That sounds interesting. And then let's go down to the
• 14:27
  Speaker 1: hardware because I see you wearing it on. Kind of
• 14:29
  Speaker 1: let's play a little game of like comparing contrast. So
• 14:32
  Speaker 1: with that ring kind of look, if I didn't know better,
• 14:36
  Speaker 1: I saw you walk it on the street. I would think, oh,
• 14:38
  Speaker 1: he's wearing an aura ring, but what is, what is
• 14:41
  Speaker 1: different in the hardware with the happy ring versus the
• 14:44
  Speaker 1: competition out there?
• 14:45
  Speaker 2: Yeah. So I appreciate your, your comment there.
• 14:48
  Speaker 3: Our goal was always to make a medical device that
• 14:50
  Speaker 3: could masquerade as a consumer device. So you look at
• 14:53
  Speaker 3: it and you think, oh, there's another consumer product. but
• 14:57
  Speaker 3: underneath the hood is where the difference lives. And so
• 15:00
  Speaker 3: what we have on the happy ring is a, we
• 15:04
  Speaker 3: do use something called sensor fusion. So we take multiple
• 15:07
  Speaker 3: different sensing types and we integrate those into a unified
• 15:11
  Speaker 3: data model. Those sensors include broad spectrum PPG. PPG is
• 15:17
  Speaker 3: a light technology that allows us to be able to
• 15:20
  Speaker 3: see what's happening under the skin. Similar, if you went
• 15:23
  Speaker 3: into a hospital, like into an intensive care unit, and
• 15:25
  Speaker 3: you saw somebody with a red light on their finger,
• 15:27
  Speaker 3: that's using a PPG-based technology. We've miniaturized that and put
• 15:31
  Speaker 3: that into a wearable. Unlike other devices that are out there,
• 15:36
  Speaker 3: we use something called broad spectrum PPG.
• 15:38
  Speaker 2: So we use multiple.
• 15:39
  Speaker 3: Wavelengths of light, in fact, four of them, which essentially
• 15:42
  Speaker 3: gives us more bites at the apple, more opportunity to
• 15:46
  Speaker 3: see features and to be able to identify certain aspects
• 15:53
  Speaker 3: of health that we're looking for that would maybe not
• 15:56
  Speaker 3: be visible if you were only using a single wavelength
• 15:58
  Speaker 3: of light. In addition to the PPG package, we also
• 16:02
  Speaker 3: have something called electrodermal activity, sometimes also referred to as
• 16:07
  Speaker 3: GSR or galvanic skin response sensors.
• 16:10
  Speaker 2: This is a proprietary package.
• 16:12
  Speaker 3: Typically, this is a technology that's only available in a
• 16:15
  Speaker 3: research or a clinical setting, big desktop kind of a
• 16:19
  Speaker 3: product that, again, we miniaturized and embedded into a wearable ring.
• 16:24
  Speaker 3: And what that allows us to do is measure the
• 16:27
  Speaker 3: brain from the finger.
• 16:29
  Speaker 2: Okay.
• 16:30
  Speaker 3: So we can literally measure activity of the autonomic nervous
• 16:34
  Speaker 3: system in real time from your finger, which is kind
• 16:37
  Speaker 3: of crazy. It's kind of science fiction. But why that
• 16:41
  Speaker 3: matters is now not only are we seeing what is
• 16:45
  Speaker 3: happening in the tissue from an optical perspective, but there's
• 16:49
  Speaker 3: other important pressure and fluid dynamic properties that are measurable
• 16:54
  Speaker 3: from an electrodermal package. And when you combine those together,
• 16:58
  Speaker 3: this is just an example of how that kind of
• 17:00
  Speaker 3: combination effect allows us to be able to see things
• 17:04
  Speaker 3: that other more simplistic sensor packages are unable to see.
• 17:08
  Speaker 1: It's fascinating because, yeah, it's being able to see so
• 17:12
  Speaker 1: much data from one ring. Was this a case where
• 17:17
  Speaker 1: other companies knew this, but they just didn't want to
• 17:20
  Speaker 1: put the investment into that because they wanted to just
• 17:22
  Speaker 1: focus on that branding like we were talking about earlier?
• 17:25
  Speaker 1: Or was there something that you had to develop that
• 17:28
  Speaker 1: you were able to develop that other companies haven't been
• 17:31
  Speaker 1: able to do yet?
• 17:33
  Speaker 3: So one of the really unique things about our company
• 17:35
  Speaker 3: is we come from a deep science and clinical background.
• 17:39
  Speaker 3: And that definitely is a unique advantage that we have.
• 17:44
  Speaker 3: My previous two companies were focused on sensor signal optimization
• 17:50
  Speaker 3: and how do you take data that is typically only
• 17:53
  Speaker 3: available in intensive care unit and how do you collect
• 17:57
  Speaker 3: that in the real world? And it turns out it's
• 17:59
  Speaker 3: a lot harder to do that in the real world
• 18:01
  Speaker 3: because you In an ICU setting, people are usually quite still,
• 18:05
  Speaker 3: and the environment is very well kind of curated and controlled.
• 18:09
  Speaker 3: Whereas in the real world, people are doing all sorts
• 18:12
  Speaker 3: of things, and that creates an incredible noise source that
• 18:18
  Speaker 3: you have to kind of filter through and be able
• 18:20
  Speaker 3: to fix. Identifying what is the signal, what is the noise,
• 18:25
  Speaker 3: how do you remove the noise, how do you boost
• 18:27
  Speaker 3: the signal, and then how do you use that for
• 18:29
  Speaker 3: your kind of predictive modeling. And so that background in
• 18:33
  Speaker 3: deep biosciences and in sensor signal optimization is an advantage
• 18:41
  Speaker 3: that we have, perhaps, over others that are in the
• 18:44
  Speaker 3: market that are approaching it similarly. Also, we started with
• 18:49
  Speaker 3: a different mission. It's a lot faster to build a
• 18:53
  Speaker 3: consumer brand than it is to build a health brand.
• 18:56
  Speaker 3: by just definition within healthcare. You have to go through
• 18:59
  Speaker 3: that clinical validation. You have to go through the FDA
• 19:02
  Speaker 3: clearance process. You have to build your quality systems and
• 19:06
  Speaker 3: your manufacturing and supply chains in a way that is auditable,
• 19:10
  Speaker 3: in a way that is consistent with best health standards.
• 19:13
  Speaker 2: That takes a lot of cost. That takes a lot
• 19:15
  Speaker 2: of time.
• 19:16
  Speaker 3: And we were willing to go kind of the slow
• 19:19
  Speaker 3: route to get there, recognizing that if we built the
• 19:22
  Speaker 3: foundation strong, that we would have the opportunity to deliver
• 19:27
  Speaker 3: care in a way that others who maybe got to
• 19:29
  Speaker 3: market quicker are unable to.
• 19:31
  Speaker 1: Yeah, because then that gets you access to eventually reimbursement
• 19:35
  Speaker 1: and doctors prescribing the ring and everything to diagnose these patients.
• 19:39
  Speaker 1: Let's dive into PPG, though, a little bit more, because
• 19:42
  Speaker 1: I had to understand what that meant. And what exactly
• 19:46
  Speaker 1: is a PPG doing with measure how to measure basically
• 19:52
  Speaker 1: the blood pressure? And then when we dive into sleep apnea,
• 19:55
  Speaker 1: some of the other characteristics that could diagnose sleep apnea.
• 19:59
  Speaker 2: Yeah.
• 19:59
  Speaker 3: So when you shine that light into the tissue, that
• 20:02
  Speaker 3: light creates sort of a banana shaped arc that comes
• 20:06
  Speaker 3: back and is measured by a sensor called on the
• 20:09
  Speaker 3: device as well. And so there are changes that happen
• 20:13
  Speaker 3: to the quality of that light as it makes that
• 20:16
  Speaker 3: banana-shaped arc through the tissue that is descriptive of a
• 20:20
  Speaker 3: variety of things that is happening with inside the body.
• 20:23
  Speaker 3: So when you look at, for example, a blood cell,
• 20:29
  Speaker 3: that blood cell will undergo a geometric shift depending on
• 20:36
  Speaker 3: if it's bound to an oxygen molecule or not. That
• 20:40
  Speaker 3: geometric shift results in a slight color change of the cell,
• 20:45
  Speaker 3: which is then measurable by those photons as they're going
• 20:48
  Speaker 3: through the body. So you can measure things like changes
• 20:51
  Speaker 3: in oxygen status. You can look at things like the
• 20:55
  Speaker 3: heart rate as you're measuring those kind of pulsatile characteristics
• 21:01
  Speaker 3: of the blood as they're coursing through the arteries and
• 21:04
  Speaker 3: veins and capillaries. When you combine that information with what
• 21:09
  Speaker 3: we have on the ring that we talked about previously
• 21:11
  Speaker 3: with the galvanic skin response, is now we have the
• 21:15
  Speaker 3: ability to understand what is happening inside the blood vessel,
• 21:18
  Speaker 3: what's happening at the blood cell level, what's happening at
• 21:22
  Speaker 3: the blood flow level. But now we can look at
• 21:24
  Speaker 3: what is happening at the tissue level as well. We
• 21:27
  Speaker 3: can look at the amount of fluid that is in
• 21:29
  Speaker 3: the tissue. We can look at the pressure that that
• 21:32
  Speaker 3: is exerting on the surrounding tissue. We can look at
• 21:36
  Speaker 3: the pressure that is being actually exerted on the walls
• 21:39
  Speaker 3: of the vessels themselves. And when you combine all that together,
• 21:42
  Speaker 3: you have the ability to measure blood pressure, which is
• 21:47
  Speaker 3: something that up until now has never been possible in
• 21:49
  Speaker 3: a wearable.
• 21:50
  Speaker 1: Two thoughts here. First off, it kind of sounds like
• 21:53
  Speaker 1: radar technology where when you're out on scene, you're blipping
• 21:59
  Speaker 1: the signal and it bounces back and the time it
• 22:01
  Speaker 1: takes to get back or the strength of the comes back,
• 22:04
  Speaker 1: that measures then whether there's a ship out there in
• 22:07
  Speaker 1: the distance. Is that kind of the same way, but
• 22:09
  Speaker 1: with different colors of the blood bouncing back creates a
• 22:13
  Speaker 1: different signal?
• 22:14
  Speaker 3: Yeah, I think that's a very helpful analogy to understand
• 22:16
  Speaker 3: what maybe I got a little bit in the weeds
• 22:18
  Speaker 3: of trying to explain.
• 22:19
  Speaker 1: Yeah, no, no, but it's like, you know, for me,
• 22:20
  Speaker 1: it's interesting too, because, you know, just being able to
• 22:23
  Speaker 1: understand how that technology works and everything. The second thing is,
• 22:27
  Speaker 1: My understanding of the PPG as well is that there
• 22:31
  Speaker 1: needs to be a sign that the heart had the
• 22:35
  Speaker 1: electric signal to start the ventricle to pump the blood out.
• 22:39
  Speaker 1: And then that time it takes the blood to get
• 22:41
  Speaker 1: to your finger. That's how you do the measurement for
• 22:44
  Speaker 1: the blood pressure. But it doesn't sound like you need
• 22:47
  Speaker 1: an ECG reader for or like a separate ECG reader
• 22:52
  Speaker 1: on your chest to be able to make the measurements
• 22:54
  Speaker 1: on the happy ring. Is that kind of the other
• 22:56
  Speaker 1: hardware features like the GSR, the other features that help
• 23:00
  Speaker 1: create that measurement?
• 23:01
  Speaker 2: Yeah, that is correct.
• 23:02
  Speaker 3: The technology to measure blood pressure from the ring is
• 23:05
  Speaker 3: entirely embedded in the ring. So it does not require
• 23:08
  Speaker 3: an ECG or any type of external source. Also, it
• 23:11
  Speaker 3: doesn't require a blood pressure cuff to calibrate. There are
• 23:14
  Speaker 3: other technologies that have been on the market that are
• 23:17
  Speaker 3: trying to measure a trending level of accuracy of blood pressure,
• 23:21
  Speaker 3: sometimes also referred to as relative blood pressure. but those
• 23:24
  Speaker 3: still require a cuff in the loop. I have to
• 23:26
  Speaker 3: come on and I have to put that on my body,
• 23:29
  Speaker 3: usually once a day, to kind of like recalibrate and adjust,
• 23:32
  Speaker 3: which obviously is very complicated from a usability perspective if
• 23:36
  Speaker 3: somebody has to remember both to use a cuff and
• 23:39
  Speaker 3: to use a wearable device. With the Happy Ring, it
• 23:43
  Speaker 3: doesn't require a cuff. It doesn't require an ECG. It
• 23:46
  Speaker 3: uses just the embedded sensors on the ring to take
• 23:49
  Speaker 3: those measurements.
• 23:50
  Speaker 1: How was the conversation with the FDA about all this
• 23:52
  Speaker 1: with the calibration and everything? Because it's a whole novel
• 23:56
  Speaker 1: technology for them. So they had to learn it on
• 23:58
  Speaker 1: the fly, kind of like how I had to learn
• 24:00
  Speaker 1: while I was preparing.
• 24:00
  Speaker 2: For this episode.
• 24:02
  Speaker 1: So what was their initial take on this technology when
• 24:08
  Speaker 1: it came in? And what were you guys able to
• 24:11
  Speaker 1: show that got them to greenlight this approval?
• 24:14
  Speaker 2: Yeah, so.
• 24:16
  Speaker 3: Blood pressure is something that we've been talking about in
• 24:18
  Speaker 3: the industry for a long time, in the wearables industry.
• 24:22
  Speaker 3: I think it's been about 12 years that Apple has
• 24:25
  Speaker 3: been talking about putting blood pressure onto a watch. And
• 24:29
  Speaker 3: so this is something that the agency has had a
• 24:32
  Speaker 3: lot of experience and conversations with various manufacturers about. But
• 24:37
  Speaker 3: we are in the unique position to have received the
• 24:40
  Speaker 3: only clearance that the agency has ever issued for cuffless
• 24:44
  Speaker 3: calibrationless blood pressure. And so because we were the first,
• 24:49
  Speaker 3: that required a higher level of scrutiny and evaluation. It
• 24:54
  Speaker 3: meant that we had to produce larger data sets. It
• 24:58
  Speaker 3: means that our data sets and the patients that were
• 25:01
  Speaker 3: recruited into those studies had to cover a broader range
• 25:05
  Speaker 3: of kind of the human health condition. And That is
• 25:11
  Speaker 3: obviously a lot more kind of cost in order to
• 25:14
  Speaker 3: be able to go through that process and to satisfy
• 25:16
  Speaker 3: those requests. But also at the end of the day,
• 25:19
  Speaker 3: it makes the FDA clearance that much more valuable. And
• 25:22
  Speaker 3: more importantly, it makes its utility in real world setting
• 25:25
  Speaker 3: more valuable. as we know that it'll work on any
• 25:29
  Speaker 3: person who comes on and engages with our product.
• 25:31
  Speaker 1: Well, that's the good thing about being the pioneers. You
• 25:33
  Speaker 1: can create the market as you see fit. Is it,
• 25:35
  Speaker 1: was that kind of the data you had to show
• 25:37
  Speaker 1: the FDA similar? I'm thinking once again, going back to
• 25:39
  Speaker 1: the CGM world where, you know, the Dexcoms and the Abbots,
• 25:43
  Speaker 1: they actually had to do a trial where it compared
• 25:45
  Speaker 1: the CGM on the arm, but they still have the
• 25:47
  Speaker 1: patients or the subjects, you know, do a blood draw
• 25:50
  Speaker 1: and they did that kind of testing to see what
• 25:52
  Speaker 1: the accuracy was between the two readings at that time.
• 25:55
  Speaker 1: Was that kind of a similar thing where you actually
• 25:56
  Speaker 1: had to have the patients do a cuff reading and
• 25:59
  Speaker 1: then you compared it to what the reading was on
• 26:01
  Speaker 1: the ring at that time?
• 26:02
  Speaker 3: So actually, our validation was against an arterial line. So
• 26:06
  Speaker 3: we had patients that came into a clinical setting. We
• 26:09
  Speaker 3: hired a contract research organization that did the study for us.
• 26:15
  Speaker 3: But they had anesthesiologists on staff that would put the
• 26:19
  Speaker 3: arterial line into the patient and was actually taking those
• 26:23
  Speaker 3: pressure measurements from inside the vessels themselves. So an arterial
• 26:27
  Speaker 3: line is considered the gold standard for blood pressure measurements.
• 26:30
  Speaker 3: It is also the only option if you want something
• 26:34
  Speaker 3: that is continuous, right? A cuff, you're going to be
• 26:36
  Speaker 3: able to get one measurement, maybe two over the course
• 26:39
  Speaker 3: of an entire trial. And so it was against those
• 26:43
  Speaker 3: arterial line references that we validated the happy ring technology.
• 26:46
  Speaker 2: Yeah.
• 26:47
  Speaker 1: I mean, it's compelling to get that data to get
• 26:50
  Speaker 1: the FDA support to then that FDA support then helps
• 26:53
  Speaker 1: you support the market launch for blood pressure. But this
• 26:57
  Speaker 1: isn't your first time launching the happy ring in the market.
• 26:59
  Speaker 1: You've already done it with the sleep apnea. How does
• 27:03
  Speaker 1: that business model for sleep apnea work? And because you
• 27:06
  Speaker 1: are combining the telemedicine approach to it as well.
• 27:09
  Speaker 2: Yeah, absolutely.
• 27:10
  Speaker 3: So when you think about what is the kind of
• 27:13
  Speaker 3: entire underlying infrastructure that supports what we do at HAPI,
• 27:17
  Speaker 3: there's really three key components. One, we've talked about a
• 27:21
  Speaker 3: lot here, which is that FDA cleared whole body medical
• 27:24
  Speaker 3: scanning technology that's embedded in the ring. The second is
• 27:28
  Speaker 3: an AI health intelligence layer that wraps around that, that
• 27:31
  Speaker 3: maps your unique physiology, creates a baseline of that, and
• 27:37
  Speaker 3: then identifies when there is any deviation from that. That
• 27:41
  Speaker 3: takes us to the third layer, which is wraparound clinical services,
• 27:45
  Speaker 3: where we have doctors that are licensed in all 50
• 27:47
  Speaker 3: states who take that data and can, in your own home,
• 27:51
  Speaker 3: help to be able to diagnose, treat, and manage a
• 27:56
  Speaker 3: large and growing number of medical conditions, all insurance covered.
• 28:00
  Speaker 3: And so when you look at that kind of combined
• 28:04
  Speaker 3: experience stack, There's a lot of things that people suffer
• 28:08
  Speaker 3: with in their daily lives that they shouldn't have to.
• 28:12
  Speaker 2: Sleep is an incredible example of that.
• 28:16
  Speaker 3: Um, sleep we know is important in a wearable context
• 28:19
  Speaker 3: because it's the number one, like most requested feature in wearables, right?
• 28:23
  Speaker 3: It's why people buy their aura ring or their.
• 28:26
  Speaker 2: Whoop band or their Apple watch or whatnot.
• 28:28
  Speaker 3: Um, sleep also is the number one search for health
• 28:33
  Speaker 3: term on Google. When people are trying to understand, why
• 28:37
  Speaker 3: am I sleepy? Why am I tired all the time?
• 28:39
  Speaker 3: Why don't I have energy in my life like I
• 28:41
  Speaker 3: used to? And it turns out that sleep is the
• 28:43
  Speaker 3: things that people care about in their 20s and 30s
• 28:45
  Speaker 3: and their 40s because it relates to quality of life
• 28:48
  Speaker 3: and kind of earning potential and things like that. And
• 28:50
  Speaker 3: it's also the harbinger of things to come and relates
• 28:53
  Speaker 3: to the major chronic conditions that we deal with in
• 28:57
  Speaker 3: our 50s and 60s and 70s and beyond. And so
• 28:59
  Speaker 3: what we saw with sleep apnea and other sleep conditions
• 29:03
  Speaker 3: that we diagnose and treat on the Happy platform is
• 29:05
  Speaker 3: that if we could combine a product experience with what
• 29:09
  Speaker 3: people care about early on, we could then continue that
• 29:13
  Speaker 3: product experience for those individuals over time and not only
• 29:17
  Speaker 3: help them feel better now, but improve the quality of
• 29:20
  Speaker 3: the life and the quantity of their life over time.
• 29:24
  Speaker 3: So the Happy Ring is the only wearable product That
• 29:28
  Speaker 3: moves from tracking bad sleep to be able to fix
• 29:31
  Speaker 3: bad sleep. And somebody can come to our website, happysleep.com.
• 29:36
  Speaker 3: We ship the ring to their house. No physician referral required.
• 29:40
  Speaker 3: And in a single night of monitoring, we can identify
• 29:44
  Speaker 3: any of four medical conditions, including sleep apnea, insomnia, circadian
• 29:49
  Speaker 3: rhythm disorder, and restless leg syndrome, and help that individual
• 29:53
  Speaker 3: to understand what is the underlying cause of the symptoms
• 29:55
  Speaker 3: that brought them there in the first place. And then
• 29:57
  Speaker 3: help them to get treatment and prove that that treatment
• 30:00
  Speaker 3: is working over time.
• 30:02
  Speaker 1: Love to go through that process in a second. But
• 30:04
  Speaker 1: when you're talking about sleep health and everything, we had
• 30:06
  Speaker 1: a guest on a couple months ago. And we talked
• 30:08
  Speaker 1: about all the main disease verticals, whether it's cardiovascular, neurovascular.
• 30:15
  Speaker 1: And the common theme for all of them was this
• 30:18
  Speaker 1: horizontal column, let's say, or horizontal row. And it was
• 30:23
  Speaker 1: sleep health. And sleep health was a cause to all
• 30:26
  Speaker 1: those different verticals. So I understand and appreciate the sleep
• 30:29
  Speaker 1: health component of it. Going to your website, ordering the
• 30:36
  Speaker 1: ring without a doctor referral, how does that then translate
• 30:41
  Speaker 1: to being able to get that insurance coverage? Because you
• 30:43
  Speaker 1: said that it's the potential for you to be able
• 30:45
  Speaker 1: to get the insurance coverage as well. So how is that?
• 30:48
  Speaker 1: process work of being able to get that insurance coverage?
• 30:51
  Speaker 1: Because that's a key feature difference, too, between Happy Ring
• 30:54
  Speaker 1: and the competitors out there, is that you're able to
• 30:56
  Speaker 1: get that reimbursement. But how does that work in the
• 31:00
  Speaker 1: telemedicine platform?
• 31:02
  Speaker 3: Yeah, that insurance coverage is critical, right? Especially when you
• 31:05
  Speaker 3: look at the larger opportunity to.
• 31:08
  Speaker 2: Be able to democratize access to healthcare, right?
• 31:11
  Speaker 3: About improving access to people who may not have $ 500
• 31:15
  Speaker 3: to $ 1, 000 to spend on a wearable device, well, how
• 31:18
  Speaker 3: do you help them too?
• 31:20
  Speaker 2: So that insurance coverage is the answer.
• 31:21
  Speaker 3: And that comes because of our clinical validation and our
• 31:24
  Speaker 3: FDA clearance and the ability to tie the services from
• 31:28
  Speaker 3: the ring to reimbursable services like the diagnosis and treatment
• 31:34
  Speaker 3: of a sleep disorder or a heart health disorder or
• 31:37
  Speaker 3: something like that. So when somebody comes to our website,
• 31:40
  Speaker 3: they're going to go through a typical checkout flow just
• 31:43
  Speaker 3: like you would if you were buying a t-shirt online.
• 31:46
  Speaker 3: The difference is that we give people the ability to
• 31:50
  Speaker 3: look up their insurance. We have an insurance lookup technology
• 31:53
  Speaker 3: that will do that automatically for most people. So that way,
• 31:56
  Speaker 3: if you don't have your card handy, you don't have
• 31:59
  Speaker 3: to go and go hunting for it. We can find
• 32:02
  Speaker 3: it for you. Sometimes people will put it in as well,
• 32:06
  Speaker 3: but we can know in real time what the coverage
• 32:09
  Speaker 3: amount is based off of their insurance plan and therefore
• 32:12
  Speaker 3: what their out of pocket costs.
• 32:13
  Speaker 2: Are going to be.
• 32:15
  Speaker 3: And what that does is that drops that cost of
• 32:17
  Speaker 3: ownership from Many hundreds to $ 1, 000 down to our average
• 32:22
  Speaker 3: customer is paying less than $ 100. Many of them are
• 32:25
  Speaker 3: completely covered by their insurance, meaning it's free. And that's
• 32:29
  Speaker 3: a pretty compelling value proposition to go from hundreds of
• 32:32
  Speaker 3: dollars for a device that's tracking my sleep to a
• 32:35
  Speaker 3: free device and clinical experience that's fixing my bad sleep.
• 32:40
  Speaker 2: Yeah, I mean, that's the thing.
• 32:41
  Speaker 1: I'm sure for the insurance companies, too, where they're giving
• 32:43
  Speaker 1: the okay for this is they see the long-term potential
• 32:46
  Speaker 1: benefit of this in the long run where the disease
• 32:49
  Speaker 1: does not progress as far as it should or maybe
• 32:51
  Speaker 1: doesn't even progress at all because you're getting the right
• 32:53
  Speaker 1: treatment to do the sleep, which I believe then that's
• 32:56
  Speaker 1: the third layer, right? It's once you get the ring,
• 33:01
  Speaker 1: insurance covers it, you wear the ring overnight a few
• 33:03
  Speaker 1: nights to get that sleep apnea diagnosis. Does that data
• 33:08
  Speaker 1: then get transferred to their normal sleep specialists or is
• 33:12
  Speaker 1: that going through the telemedicine health process again? I mean,
• 33:17
  Speaker 1: how do we get that to that full circle where
• 33:19
  Speaker 1: the patient gets the ring and then gets the treatment
• 33:22
  Speaker 1: they need?
• 33:22
  Speaker 3: Yeah, so we have an in-house clinical network. So we
• 33:26
  Speaker 3: have physicians that are, for example, and you're talking about sleep,
• 33:30
  Speaker 3: that are boarded in sleep medicine, licensed in all 50 states.
• 33:33
  Speaker 3: So it doesn't matter what zip code you live in,
• 33:35
  Speaker 3: where you're coming from, we will be able to provide
• 33:39
  Speaker 3: that comprehensive service experience for you. And that's really important
• 33:44
  Speaker 3: of owning that full experience stack because when you look
• 33:47
  Speaker 3: at sleep, for example, it takes on average four to
• 33:51
  Speaker 3: six months for somebody to go through the process to
• 33:55
  Speaker 3: get diagnosed with a sleep disorder if they're going through
• 33:58
  Speaker 3: traditional sleep medicine pathways.
• 34:01
  Speaker 2: At Happy, we do it in less than 11 days.
• 34:04
  Speaker 3: And that speed is only possible if we've integrated every
• 34:08
  Speaker 3: part of the experience.
• 34:11
  Speaker 1: Yeah.
• 34:11
  Speaker 2: And I mean, that's the thing.
• 34:12
  Speaker 1: You got that full circle to get that patient treated
• 34:14
  Speaker 1: a lot sooner, get the process started. Is that something
• 34:18
  Speaker 1: that where I'm thinking like, like in a CPAP device,
• 34:21
  Speaker 1: is that the, is that the ultimate device that they
• 34:23
  Speaker 1: may get through this process that your, your telemedicine specialists
• 34:27
  Speaker 1: go out and say, Hey, prescribe this through the DME.
• 34:30
  Speaker 2: It gets delivered.
• 34:30
  Speaker 1: You know, I'm thinking of a ResMed device that, Is
• 34:33
  Speaker 1: that kind of the final, is that the path for
• 34:35
  Speaker 1: them to be able to get those CPAP devices essentially
• 34:38
  Speaker 1: or whatever device is best for them for their treatment
• 34:40
  Speaker 1: of their sleep apnea?
• 34:42
  Speaker 2: It's a great question.
• 34:43
  Speaker 3: So there are eight medical conditions that we diagnose and
• 34:46
  Speaker 3: screen for on Happy Ring. One of those is sleep apnea.
• 34:50
  Speaker 3: Within the sort of specific area of sleep apnea, there
• 34:54
  Speaker 3: are really two frontline therapies that are FDA cleared and recommended.
• 34:59
  Speaker 3: One of those is CPAP. which includes the mask and
• 35:02
  Speaker 3: the tube and the machine, right? Kind of the things
• 35:04
  Speaker 3: that maybe our uncle uses, right? Or something like that.
• 35:07
  Speaker 3: And then the other is actually a dental device. So
• 35:10
  Speaker 3: it's basically, think of it as a custom fit aligner
• 35:13
  Speaker 3: tray on top and bottom that's connected usually with a
• 35:16
  Speaker 3: band of some kind that helps to prevent the jaw
• 35:19
  Speaker 3: from falling backwards while you sleep. So a CPAP machine
• 35:23
  Speaker 3: does that by pushing air into the airway and keeping
• 35:26
  Speaker 3: it open. And the dental device does it mechanically by
• 35:29
  Speaker 3: just preventing the jaw from falling backwards. We provide both
• 35:33
  Speaker 3: of those through the happy experience. We're big believers in
• 35:37
  Speaker 3: being agnostic to treatment options and allowing people to be
• 35:41
  Speaker 3: able to choose what is most appropriate for them. And
• 35:44
  Speaker 3: appropriateness is going to come down to several factors, including
• 35:48
  Speaker 3: what is the clinical indication?
• 35:50
  Speaker 2: What is their motivation?
• 35:52
  Speaker 3: You know, the things that brought them there and that
• 35:54
  Speaker 3: they care about. And then how do they plan on
• 35:56
  Speaker 3: paying for it? But by combining those together and then
• 36:00
  Speaker 3: having a telemedicine consult where just like we are here
• 36:03
  Speaker 3: now sitting down and talking to somebody about what matters
• 36:06
  Speaker 3: to them and what their goals are and how we
• 36:07
  Speaker 3: can support, we're really flipping that care model from the
• 36:11
  Speaker 3: doctor will see you now, right? The white coat is
• 36:13
  Speaker 3: the one who's the authority and it tells you what
• 36:15
  Speaker 3: to do to a model of the patient will see
• 36:19
  Speaker 3: you now. And we're giving you the data and we're
• 36:21
  Speaker 3: giving you the support to make the right choice for you.
• 36:25
  Speaker 2: And then helping make that easy.
• 36:27
  Speaker 1: Yeah. And so you talked about eight of them besides
• 36:30
  Speaker 1: sleep apnea. What are the other seven? Is that including blood.
• 36:34
  Speaker 2: Pressure now and there? So one of those is definitely
• 36:37
  Speaker 2: blood pressure.
• 36:39
  Speaker 3: One of the really cool things that comes out of
• 36:41
  Speaker 3: the ability of being able to measure so many things
• 36:45
  Speaker 3: goes back to part of our earlier conversation in the
• 36:49
  Speaker 3: ability to be proactive rather than reactive. Yeah. By looking
• 36:55
  Speaker 3: at those 2.8 million data points every single night, we
• 36:59
  Speaker 3: can actually see disease before it occurs. So one of
• 37:03
  Speaker 3: those eight that we have the ability to screen for
• 37:07
  Speaker 3: is heart disease. That's really cool. Hypertension is the single
• 37:13
  Speaker 3: largest modifiable risk factor for the number one cause of
• 37:18
  Speaker 3: disease and death in the United States, which is heart disease. Yeah.
• 37:22
  Speaker 3: If you can predict a cardiovascular event like a stroke
• 37:27
  Speaker 3: or a heart attack before it occurs, not only are
• 37:30
  Speaker 3: you preventing somebody from going to the hospital, which obviously
• 37:35
  Speaker 3: is a very disruptive and a very expensive experience, but
• 37:39
  Speaker 3: more importantly is the impact it has on that individual
• 37:43
  Speaker 3: from a health and a quality of life perspective. 16
• 37:47
  Speaker 3: years are lost from the average heart attack. Five and
• 37:52
  Speaker 3: a half years are lost or about a third of
• 37:55
  Speaker 3: remaining lifespan from the average stroke. And so what we're
• 37:59
  Speaker 3: talking about is now with the happy ring, we can
• 38:03
  Speaker 3: predict these events before they happen. We can alert somebody
• 38:09
  Speaker 3: to the likelihood of something happening within less than 12
• 38:14
  Speaker 3: months and then connect them with the care they need
• 38:18
  Speaker 3: to hopefully be able to avoid that altogether.
• 38:21
  Speaker 1: Yeah, I mean, that goes to the whole proactive side
• 38:24
  Speaker 1: of the business. And my reading beforehand, you know, they
• 38:27
  Speaker 1: talked about arterial stiffness and atherosclerosis as kind of some
• 38:31
  Speaker 1: of the next opportunities for PPG. So it sounds like
• 38:34
  Speaker 1: that's the path they can take. Let's talk about blood
• 38:37
  Speaker 1: pressure then, because you gave a great overview of the
• 38:40
  Speaker 1: sleep apnea business model. Is the blood pressure model going
• 38:43
  Speaker 1: to be similar or are there going to be some
• 38:46
  Speaker 1: caveats that make it a little bit different than the
• 38:48
  Speaker 1: current model?
• 38:49
  Speaker 3: So there are definitely similarities and differences. Similar to sleep,
• 38:54
  Speaker 3: you don't get diagnosed by a test. You get diagnosed
• 38:58
  Speaker 3: by a clinician who reviews the results of the test
• 39:01
  Speaker 3: and everything else in your kind of presenting history and
• 39:04
  Speaker 3: determines what the appropriate diagnosis is for you. Hypertension is
• 39:09
  Speaker 3: the same way. So we have the ability to passively
• 39:13
  Speaker 3: monitor blood pressure on an ongoing basis anytime somebody puts
• 39:18
  Speaker 3: on the ring. That data is then transmitted to a
• 39:22
  Speaker 3: care team, including physicians, who are reviewing that data to
• 39:26
  Speaker 3: understand what is happening in your heart and your vascular health,
• 39:30
  Speaker 3: including if you have hypertension. Almost half of American adults
• 39:36
  Speaker 3: have hypertension. Over 120 million adults in the United States
• 39:42
  Speaker 3: have high blood pressure. Three quarters of those are not
• 39:47
  Speaker 3: being properly managed, either because they don't know they have
• 39:49
  Speaker 3: it or a variety of other reasons. But the limitation
• 39:52
  Speaker 3: doesn't come down to not having good medication. We have
• 39:55
  Speaker 3: great medication for managing hypertension and therefore all the other
• 39:59
  Speaker 3: downstream effects that that causes. The problem is that we
• 40:03
  Speaker 3: don't have good screening and monitoring technology to help make
• 40:06
  Speaker 3: sure that somebody is identified And that the medication choices
• 40:12
  Speaker 3: and their actual taking of those medications are helping to
• 40:15
  Speaker 3: bring that into a healthy level. You used the continuous
• 40:19
  Speaker 3: glucose monitoring example previously. Imagine if we were managing somebody's
• 40:24
  Speaker 3: diabetes and we said, hey, we took one blood stick
• 40:28
  Speaker 3: measurement three years ago. We think you're fine. Nobody would
• 40:33
  Speaker 3: be managed for their blood sugar. We're kind of doing
• 40:35
  Speaker 3: that right now with hypertension, but with the clearance for
• 40:39
  Speaker 3: the happy ring, we have the opportunity to completely change that,
• 40:42
  Speaker 3: which is that integrated kind of coordination between the device,
• 40:48
  Speaker 3: the agentic monitoring, and then the clinicians who can intervene
• 40:54
  Speaker 3: when needed to make sure that somebody's getting the care
• 40:55
  Speaker 3: they need.
• 40:56
  Speaker 1: And so will that then be done through the website again?
• 41:00
  Speaker 1: Or is this point, is the doctor going to be
• 41:02
  Speaker 1: your call point and say, hey, you've diagnosed these patients
• 41:05
  Speaker 1: with hypertension, utilize our ring and to be able to
• 41:09
  Speaker 1: continuously monitor them to make sure that, you know, they're
• 41:14
  Speaker 1: being adherent with taking their antihypertension medicine. If they need
• 41:19
  Speaker 1: to come in because it's worsening sooner, then wait till
• 41:21
  Speaker 1: their six month appointment comes up. Or is it going
• 41:25
  Speaker 1: to go through the website still?
• 41:27
  Speaker 3: So this kind of hypertension monitoring as a service opportunity is,
• 41:33
  Speaker 3: is able to meet people where they are, regardless of
• 41:36
  Speaker 3: where they are, right? We're not trying to bring you
• 41:38
  Speaker 3: to health care. We're trying to bring health care to you.
• 41:41
  Speaker 3: And so some of the opportunity that we have that
• 41:46
  Speaker 3: has shown to that is really exciting for us is
• 41:51
  Speaker 3: the opportunity to work with hospitals and with health systems
• 41:54
  Speaker 3: and with medical groups, both in primary care as well
• 41:57
  Speaker 3: as within specialty care, who have large populations of patients
• 42:01
  Speaker 3: that they're trying to monitor and manage, but they don't
• 42:03
  Speaker 3: have the ability to do so. It's really hard to
• 42:06
  Speaker 3: get somebody to take a daily blood pressure measurement when
• 42:08
  Speaker 3: they have to stop their daily life, they have to
• 42:10
  Speaker 3: sit still, they have to put the cuff on, they
• 42:12
  Speaker 3: have to write down the measurement and then call the
• 42:14
  Speaker 3: nurse and say, this is what it was. That complexity
• 42:18
  Speaker 3: just makes the whole process breakdown. And so being able
• 42:22
  Speaker 3: to provide this monitoring service for these large established players
• 42:26
  Speaker 3: within the healthcare space is really exciting. But there's also
• 42:30
  Speaker 3: a lot of patients who are living their lives thinking
• 42:33
  Speaker 3: that they're healthy and that there's nothing wrong. They're rationalizing
• 42:37
  Speaker 3: away what they're feeling, or maybe they're just due to
• 42:40
  Speaker 3: some stigma or some other reason, they're pretending that it's
• 42:43
  Speaker 3: not there. We have the opportunity to help those individuals
• 42:46
  Speaker 3: who are coming in just directly through our website, identify these,
• 42:50
  Speaker 3: and then if necessary, bring those into those care systems
• 42:54
  Speaker 3: earlier that will help them to get the support they need.
• 42:57
  Speaker 2: Gotcha.
• 42:57
  Speaker 1: And I know this is so early in the process
• 42:59
  Speaker 1: because the approval is just a few weeks old at
• 43:01
  Speaker 1: this point. But is it the same type of insurance
• 43:04
  Speaker 1: coverage as with the sleep apnea yet? Do you need
• 43:06
  Speaker 1: to work with those insurance companies to kind of get
• 43:08
  Speaker 1: them to understand the importance of being so proactive in
• 43:11
  Speaker 1: the hypertension monitoring?
• 43:13
  Speaker 2: It's a great question.
• 43:14
  Speaker 3: And we're fully covered by all commercial and federal plans
• 43:18
  Speaker 3: today because all of the codes that we are billing
• 43:21
  Speaker 3: are are existing CPT codes. That means that we don't
• 43:25
  Speaker 3: have to go and get new code coverage and.
• 43:28
  Speaker 2: Work at a plan-by-plan level. Which that sometimes is a
• 43:30
  Speaker 2: multi-year process in itself. It is.
• 43:33
  Speaker 1: Yeah, okay, that's great. The other thing, too, is you've
• 43:38
  Speaker 1: also announced around this time the Series A funding that
• 43:41
  Speaker 1: you received. What's going to be the use of the
• 43:44
  Speaker 1: proceeds there? Because now you're really opening up this opportunity.
• 43:47
  Speaker 1: You talked about $ 120 million patients that could have hypertension, 75%
• 43:54
  Speaker 1: of them are undiagnosed. My background work beforehand showed that
• 43:59
  Speaker 1: there's 35 million or so with blood pressure that's above 140.
• 44:05
  Speaker 1: So if you kind of take that 25% of the 120,
• 44:08
  Speaker 1: kind of matches to that 35 million number. So it's
• 44:10
  Speaker 1: almost like you got to get to such a bad
• 44:13
  Speaker 1: level of hypertension that it requires you to go to
• 44:15
  Speaker 1: the doctor. Well, that was in like the 130, 120 range.
• 44:19
  Speaker 1: They may not realize that they're progressing there. One winded
• 44:22
  Speaker 1: way of saying, though, is with this use of the
• 44:26
  Speaker 1: Series A funding is how are you going to be
• 44:29
  Speaker 1: using this cash from the get go to kind of
• 44:31
  Speaker 1: address this large population?
• 44:33
  Speaker 3: Yeah, the funding is entirely to be able to support
• 44:36
  Speaker 3: our commercial ambitions. we've built the technology, we've built the
• 44:42
  Speaker 3: underlying hardware, the data infrastructure, the clinician network, the medical groups,
• 44:47
  Speaker 3: and all the kind of service layer support that is
• 44:51
  Speaker 3: around that. And the funding is really to be able
• 44:54
  Speaker 3: to just kind of pour gas on that fire and
• 44:56
  Speaker 3: help us be able to reach as many of those
• 44:59
  Speaker 3: patients as possible, regardless of the path that they come
• 45:03
  Speaker 3: through to find us. So Some of that is supporting
• 45:06
  Speaker 3: direct-to-consumer marketing efforts. Some of that is supporting large partnerships
• 45:11
  Speaker 3: and enterprise implementations. But ultimately, it's entirely going to helping
• 45:17
  Speaker 3: us to be able to scale our ability to access
• 45:20
  Speaker 3: and serve those patients.
• 45:20
  Speaker 2: And another thing, a.
• 45:21
  Speaker 1: Company this early in its state, is manufacturing a top
• 45:27
  Speaker 1: priority for you to be able to supply the demand potentially?
• 45:31
  Speaker 2: Absolutely. Absolutely.
• 45:33
  Speaker 3: Being able to keep up with that when you are
• 45:38
  Speaker 3: dealing with multi-month manufacturing processes from when you place an
• 45:43
  Speaker 3: order to when you actually receive the units to be
• 45:45
  Speaker 3: able to ship requires a lot of complexity and coordination
• 45:49
  Speaker 3: to ensure that you are matching your kind of supply
• 45:52
  Speaker 3: and demand in a way that is responsible for a
• 45:55
  Speaker 3: company of our size.
• 45:56
  Speaker 2: Yeah. And you have the experience.
• 45:58
  Speaker 1: Because you said you had two other companies in the
• 46:00
  Speaker 1: past where you worked on these sensor signal optimizations. What
• 46:04
  Speaker 1: were some of the lessons you took from those experiences
• 46:07
  Speaker 1: to get to where you are today? Because now you're here,
• 46:10
  Speaker 1: you got the FDA approval, you're getting the manufacturing started,
• 46:12
  Speaker 1: you're getting the business model out there. What were some
• 46:15
  Speaker 1: of the lessons previously that helped you get across this
• 46:18
  Speaker 1: finish line?
• 46:19
  Speaker 3: I think one of the things that really stood out
• 46:21
  Speaker 3: to me was the importance of simplicity. Building some really
• 46:26
  Speaker 3: capable feature set that's hard to access and use may
• 46:31
  Speaker 3: make a great story, but it doesn't provide a great
• 46:34
  Speaker 3: opportunity to do public good. You have to make it
• 46:37
  Speaker 3: so that people find it seamless and simple to be
• 46:42
  Speaker 3: able to do the thing that they maybe want to do,
• 46:45
  Speaker 3: but maybe in some cases lack some of kind of
• 46:47
  Speaker 3: the activation energy to accomplish. And so what we found
• 46:51
  Speaker 3: is that what we had to do is combine really
• 46:55
  Speaker 3: good technology with all of the kind of interstitial patient
• 46:59
  Speaker 3: support steps that were required so that people didn't drop off.
• 47:03
  Speaker 2: They didn't get lost.
• 47:05
  Speaker 3: They didn't forget what they were doing and that they
• 47:07
  Speaker 3: were able to move through very quickly.
• 47:09
  Speaker 2: To get to their end destination.
• 47:11
  Speaker 3: I think that simplicity in healthcare is something that is
• 47:15
  Speaker 3: missing at a macro level. It was definitely something that
• 47:19
  Speaker 3: I didn't appreciate early on, how important that was in
• 47:23
  Speaker 3: the delivery of that care journey experience, and something that
• 47:26
  Speaker 3: we really invested in heavily at HAPI to ensure that
• 47:29
  Speaker 3: we are creating a manifestly different healthcare experience for our patients.
• 47:34
  Speaker 1: Yeah, I think the beauty and simplicity is a great
• 47:36
  Speaker 1: quote in the long run. And so kind of closing
• 47:40
  Speaker 1: out on that segue, you know, we're here, we have
• 47:43
  Speaker 1: sleep apnea, we have blood pressure. You talked about heart disease.
• 47:47
  Speaker 1: PPG technology has talked about arterial stiffness and atherosclerosis. Where
• 47:52
  Speaker 1: do you see the future of wearables for health care
• 47:57
  Speaker 1: in five years, especially as you kind of get into
• 47:59
  Speaker 1: the third generation, fourth generation, fifth generation of this technology?
• 48:04
  Speaker 3: Our vision as a company is to make it so
• 48:06
  Speaker 3: that people never have to go to the hospital again.
• 48:08
  Speaker 3: And I know that's a little cheeky to say and
• 48:11
  Speaker 3: a little bit of an ambitious vision. But to explain
• 48:13
  Speaker 3: what I mean by that, when you look at the
• 48:15
  Speaker 3: over $ 5 trillion that we spend every year in the
• 48:18
  Speaker 3: United States on health care, 90% of that is on
• 48:21
  Speaker 3: chronic disease management. And by definition, chronic disease is happening
• 48:26
  Speaker 3: in the home, not.
• 48:27
  Speaker 2: In the hospital.
• 48:28
  Speaker 3: And so if we can create a platform that isn't
• 48:33
  Speaker 3: just looking at one aspect of health, but is looking
• 48:37
  Speaker 3: at multiple aspects of health, especially the core health conditions
• 48:41
  Speaker 3: that people are dealing with and struggling with in their
• 48:43
  Speaker 3: daily lives. If we can identify conditions early, surface those
• 48:48
  Speaker 3: to their conscious awareness, If we can make it simple
• 48:51
  Speaker 3: for them to take the next right step in their
• 48:53
  Speaker 3: health care, it means that we truly are going to
• 48:56
  Speaker 3: make it so that people don't have to go to
• 48:58
  Speaker 3: the hospital, except for in very extreme conditions where there
• 49:02
  Speaker 3: is no better place to be. But in most cases
• 49:06
  Speaker 3: in the world that we live in, in the health
• 49:08
  Speaker 3: care environment that we live in today, those services are
• 49:11
  Speaker 3: better delivered. And by better, I mean from a quality perspective,
• 49:14
  Speaker 3: from a cost perspective, from a convenience perspective in the
• 49:17
  Speaker 3: home than it is in the hospital. And that's where
• 49:20
  Speaker 3: we see wearables really making a difference and where we
• 49:23
  Speaker 3: plan to be a major player in that vision and
• 49:28
  Speaker 3: in that shift. Yeah.
• 49:29
  Speaker 1: Well, I'm excited to watch that happen over time. Dustin,
• 49:32
  Speaker 1: thank you so much for joining us today.
• 49:33
  Speaker 2: Thank you for having me.
• 49:34
  Speaker 1: And thank you to our producers, Aditya Samani and Mariam Thawale,
• 49:38
  Speaker 1: for all the behind-the-scenes work. And thank you to our
• 49:40
  Speaker 1: listeners for tuning in today. We hope you join us
• 49:42
  Speaker 1: for future episodes. And if you'd like to stay up
• 49:44
  Speaker 1: to date, you can click the subscribe button on Spotify
• 49:47
  Speaker 1: or your favorite streaming platform.
• 49:48
  Speaker 2: Take care.
• 50:12
  Speaker 3: So,