Latest / Zero Friction / Building the Future of Digital Health for Fibromyalgia Care with John Nycz || Zero Friction Podcast
Transcript
- Terry Coutsolioutsos/RevRx AI: Well, folks, to the Zero Friction Podcast. And I have a really exciting opportunity today for all of us. ⁓ Nycz who is the co-founder and CEO of Rapha Digital Health, is with us today. John has spent sort of a couple different careers. He's been in the operations business, Lean Six Sigma. He's probably spent the last 10 to 12 years in healthcare. as an operator and he's now just co-founded this new Rapha Digital Health Platform. And we're here to get a better understanding of John's history and his purpose, but also more importantly understanding what Rapha can do for healthcare purposes moving forward. So John, great to have you. Appreciate you being here. Why don't you give us a little background on yourself and Rapha as well? John: Terry, thanks for the opportunity. I actually got started on this journey in 1995, oddly enough, with the 100 mile an hour combined impact head-on collision. I suffered what was described as the same injury that would be received if you jumped out of a seven story window. And the bone wasn't healing. The surgeon suggested we fuse the joint. which would have obviously significant impact on how I conducted the rest of my life. I did some research, found information on early bone stem devices, found an that wired me up, and then over the course six weeks I went back three times a week. Long story short, hard bone growth, I've had no limitations except I can't run long distances. an amazing recovery and the way we tie that back together is in 2015 I was approached by another company about this and I learned some valuable lessons about how important it is to have the economics in place so that the research can get done even for therapeutics that were viciously effective. A lot of these devices add huge value in things like and treating non-healing wounds, neuropathy, it's pretty significant. So the way that transitions Terry is we started looking at this problem the lens of my prior experience with operational excellence, Lean Six Sigma leaders. I got to hang around with a lot of people who did some very interesting things with analytics. going to their presentations, would pick up how these connected into the business. And so when we started looking at the we're looking at now, there was a big gap with the data. ⁓ And we saw was we ⁓ looking it through the lens of treating fibromyalgia. We were asked to be involved with the project. And so was narrowly scoped out ⁓ already. The lessons I walked away from with those experts on those subjects was make sure you keep this thing scoped enough. Well, the problems with healthcare information are too huge to begin. So that's the correlation to take this thread from my sweater and walk away. We found a thread. We found something we could start pulling on in a corner that is vastly in need of improvement. And then those improvements. we can propagate across other complex chronic conditions. Terry Coutsolioutsos/RevRx AI: So what what's sort of like the main driver behind Rapha today? So we have fibromyalgia, number one, which is, you know, a a chronic disease. to ⁓ is it a is a health platform? Like w what is the the foundation and the backbone behind what Rapha's purpose and intent is? John: good place to start. It's really an ecosystem. We clinicians by getting them better information in a more timely manner and we'll get what we do with collecting that information but an electronic health record these days has a lot of things in it that don't necessarily add value for the guy or gal that's trying to what's wrong with this patient. So they've got to sort through ICD-10 codes, information about reimbursement optimization, kinds of other information are floating around in these documents. It makes it easy to streamline that and pull forward what's relevant just for those clinicians. But in this particular case, ⁓ there's some big gaps regarding education and content. They're simply not trained other alternatives. And the data set's not looking for that. the ecosystem is, I was just going to say the ecosystem ultimately allows us to ride care for patients. So the platform that we have built does a couple of things. Take advantage of the fact that telehealth for this population is such a better option because you can frequently see that Terry Coutsolioutsos/RevRx AI: Let's talk about like fibromyalgia just go ahead. John: The 90-day path that they traveled with us is much different than the five to seven years it can take for a diagnosis for these patients. And they're spending a lot of money along the way. again, the decade that I spent with those ⁓ excellence executives, the people driving process improvement in the ⁓ largest organizations, was because we looked at this and there's gaps all over. There's a lot of things that we can close with tools like Lean and control, making sure that we're compliant and making sure that we can more effectively manage business. A well-run organization can operate 20 to 30 percent less than a clinic, and 30 percent of these patients are missing their clinic appointments. So that's friction. Terry Coutsolioutsos/RevRx AI: That's friction and definitely inertia too. So, you know, let's talk about the pain points for the patient that does have fibromyalgia as well. So, you know, I know that they have their own sense of friction in their world and know it's it's hard to diagnose, it's harder to treat, it's harder to it's hard to identify what treatments work with what type of patient and you know it sounds like you know having a digital health platform that is Foundationally an ecosystem for these patients is a great start. John: really does tie together what circle back to with ⁓ a moat. The noble purpose ⁓ of we're doing is really about getting this data set together that we know has been to exclusion bias. It's simple. The chief commercial officer a pharmaceutical company doesn't necessarily a lot of the things that might have impact, will have impact, aren't relevant to what they're trying to accomplish, just being candid. But there's tons ⁓ of that's not being tracked, and when compile this information, we can see the correlations, we can monitor frequencies, can see is disease relevant as a trigger, is stress relevant as a trigger. We get more more information around that, but we also are able to see our efforts to manage gut health valid with a larger portion of the population. And it will be no simple answer, oh, we discovered that if you pull your earlobe twice, it's not that. That's where personalized, or rather, precision healthcare comes into focus. So we can use that information to drive a lot of valuable informatics for the clinician. That's really the neat, that's what gets me out of bed every morning is knowing we're actually fixing a problem. And if you talk to these people who've done the primary research and had some meaningful conversations with family members and patients that wrestle with this, can be life, can wreck your life. It's significant and a lot of comorbidities get dragged along in the way. Terry Coutsolioutsos/RevRx AI: know, the ones that I think you and I talked about earlier that, you know, eight out of ten patients that have fibromyalgia are female, right? you know, that has a a major dramatic impact on personal, professional, work life, work life balance. I mean, you know, ⁓ families, you know. John: and families, know, and predominantly, role is a big one. And multifaceted. typically, they will go three days without sleep. Think the ramifications from that, knowing just what the health impact of that is. ⁓ But fibro fog, you mentioned pain points, and I know you were talking about kind of Terry Coutsolioutsos/RevRx AI: Right. John: pain points as far as managing what's going on with all this, but think there's 18 of them that they used to track where they would have pain that during a flare up, you know, it might manifest itself in one place or another, very much like rheumatoid arthritis, absolutely devastating. It impacts their ability to work, their absenteeism, presenteeism, affects their husbands, their kids. ⁓ It can be really bad. Terry Coutsolioutsos/RevRx AI: Sure. You know, just think if you're a single mother and dealing with something like that as well, that must be really a dramatic impact when you're the only caregiver a lot of ways. So huge a lot of pain that goes with it just in terms of dealing with the the pain itself and and trying to figure out how to fix it, right? That's the other thing that you and I talked about is that there's really no way to ⁓ quickly diagnose John: is a great point. It's a diagnosis by exclusion. Another challenge that we face with today's healthcare paradigm is you simply know, can't get an appointment. It's four months, it's 60 days, 180 days. can be a long way out. So given the fact that it's a diagnosis of exclusion, it takes patients a long time to hit the frequency they need to, to gather all the information to say, it's none of these things. Therefore, it's And ⁓ can, ⁓ the telehealth world, not exclusive to what we're doing with our ecosystem, we have a lot of other benefits we'll discuss, but just in the telehealth paradigm, that frequency can be easily managed in days, couple weeks here, couple weeks there. mean, most appointments for most patients will be in the next day or two, and we'll feel bad about two. Terry Coutsolioutsos/RevRx AI: Right. So when you talk about that ecosystem, right? So what is what's underneath that ecosystem? So we talked about telehealth number one. what other parts of is there communities or is it is it a patient based community, is it a clinician-based community, or is it all of the above? So kind of describe to us what that infrastructure looks like. John: Great question. Some of it will be driven by the way we develop content. A lot of that content is used for marketing purposes. But we'll have content targeted to both the patients and some the people influenced ⁓ and in the universe the patient and to the clinician. Obviously, clinical content will be retrospective case studies, things like that. some things that we can get our teeth behind. And then the content that we build for the patient will shared in that community with the patients and selectively outside that community. But ⁓ it will everything we need to do with EEAT to make sure it's valid for AI They expected in two years to be ⁓ about half the people that were going to the Internet for Healthcare searches would be using that platform. would not be surprised if we're already there. And this prediction was made nine months ago. So very quickly moving in that direction and the content that we're developing will support that. It will also be much wider and broader than... what happens in real life with the patient's journey when they finally get to the end of this rainbow and they've received a fibromyalgia diagnosis because everything else has been ruled out over five to seven years as they've spent five grand a year out of pocket or more. The big win is, okay, now we can cover some of your insurance claims for fibromyalgia, but most of the treatment alternatives, would be for... put forward in traditional health care are going to involve pharmaceuticals. And it's not the only answer. So our mission is to widen that data set at the same time as we make sure that it's all valid and relevant. And that's another part of too. ⁓ Terry Coutsolioutsos/RevRx AI: Is there anything that is there anything that th that we can, you know, like not just treating fibromyalgia, but is there anything out there in the horizon around actually diagnosing it so that you can again get back into the sort of mindset of precision medicine versus, you know, you said that you're basically reverse you're just figuring out what's not working and it's sort of becomes the the the result of subtraction versus actually aiming at something. John: I don't think so. Here's the upside though. I had to guess, and again I should set the stage correctly, I am not a clinician but I've done a lot of homework and think what we're going to find instead, that rather than having, this is the definitive root cause of this condition because there could well be multiple. we will find that there's going to be things that make a big difference. Low inflammation, your inflammation, managing your gut health. And things won't be, hey, it fixed fibromyalgia. These things, when we get done collecting enough data and tearing it apart, will be, my god, that fixes chronic fatigue too. ⁓ that's a big help with Lyme disease, gotta start there. brain and the gut are connected and it's really interesting but some of that stuff got skipped along the way and if we collect enough data in enough spaces we can make sure as long as we can ensure that data is corrected and managed so that's why we stack the deck with a lot of these people that you know, have been running operational excellence and understand Lean Six Sigma process control, analytics, ⁓ continuous process improvement. So we actually use AI to improve the processes continually, which is interesting. Terry Coutsolioutsos/RevRx AI: So how big is the problem? Like how many people are being treated for fibromy fibromyalgia today? Like how big is that problem in America? John: It's pretty significant. Four million patients diagnosed, another million looking for answers, and the for another four million above that that ⁓ are trying find, do I have chronic fatigue, or do I have Epstein-Barr, or do I have ⁓ fibromyalgia? About million is the estimated number of people that ⁓ are wrestling these symptoms. Terry Coutsolioutsos/RevRx AI: Okay. So basically almost two percent of our population or thereabouts, right, are wrestling with those types of symptoms. John: Yeah, what was it? 2.9, I thought, something like that. Yeah, it's a pretty significant number. And again, not everybody is in, all, you they may have different levels that they're impacted at or are managing it more effectively. Another part of this population of six million people that may have fibromyalgia that have not received a diagnosis yet is a cadre of folks that, you know, I'm getting, I'm. Terry Coutsolioutsos/RevRx AI: Well. John: handling it on my own. did my own research. I know what's working. So you mentioned the communities and yes we absolutely are building communities for both and we want to have the best content and quality of information that's available in those communities. There's a lot of ⁓ great communities interaction that goes on in some of the public domains. Terry Coutsolioutsos/RevRx AI: Right. John: And there's some shady stuff too. ⁓ platforms that we've looked into that don't really have any structure behind it. Some of them are leading some great research. But in any social platform, it's a little bit of a free for all and you really do not know what is clinically relevant, what has been correctly measured, what is making a difference and what isn't. and that's primary among our missions is being able to go, ⁓ here it is, here's the data. Terry Coutsolioutsos/RevRx AI: Right. And here's a community and you know, here's here's a clinician in this market and you know, it's I think you know, when you think about the opportunity that that Rapha Digital Health has, it's not just collecting information, but it's disseminating, it's using information so people have access to it as well. you know, what are typically people like who are treating themselves, what are they treating themselves with? Is it diet, is it exercise, is it Meditation? Is it like what are you know, like how are people it doesn't sound like they're getting cured from anything by the way either. That sounds like they're treating symptoms, right? ⁓ that's the other part that, you know John: A lot of the traditional western, allopathic medicine methodology is built around asymptomatic relief. Let's at least get to the point where we can improve upon this. Which is a bit of an irony in this situation because it takes so long to get to the point where we can provide them relief with the tools that we have which are primarily When you get that diagnosis, if you've hung with it long enough, here's your script. That's the primary answer that they're going to get. We know that managing gut health has all kinds of benefits. ⁓ Inflammation kills. It's just not a good thing. If a fibromyalgia patient is drinking too much, That's just a nightmare that has to stop before anything can begin. And by being able to see things ⁓ and make that we've got good information coming in, we'll spend 90 minutes and have a couple hundred questions. And they're tiered down, so it's not like they have to answer a couple questions. But that kind of detail we need to get from... to put the longitudinal zero-party data, the direct from the patient information in that's pulled in from a clinician that knows how to manage this to get good information, it takes that. They don't get it with their 15-minute session every four months caught in the traditional paradigm. So changing that does two things. It allows us to really more efficiently care by reducing friction. it us to collect a great deal of data and we're putting out, you know, there's so much we can do now with remote monitoring and those options to get good information. Terry Coutsolioutsos/RevRx AI: So what's the game plan like ⁓ you know how do you go through guess a couple things. One is you're gonna need some sort of patient acquisition process or system, right? And then you're gonna need to recruit and get clinicians on board too, I'm guessing along some along the way as well. So what does that look like for you building this model out? John: It can scale out. Let's address the first or the last thing you said first. Clinicians will manage a number of nurse practitioners and physicians underneath them. We'll have a cadre of nurses underneath them. And we can roll it out in a cadence that allows us to scale to it. We've complicated our equation a little bit because we got some feedback. The patients that we're working with, ⁓ least in the start, and I would think this holds true with most complex chronic conditions, but they hurt. They haven't slept. They're not necessarily processing everything They do want to have to speak with resources that are abroad. So a lot of these calls for telehealth. organizations are outsourced, we've in US-based clinicians. So it makes it little more difficult, but the system that professionals are working within right now is truly treadmill. It's ⁓ really difficult ⁓ the clinicians push the amount of work product that they have to through the system. I have a friend who's surgeon. I've stayed at his home. When he's come home on clinic day after we grabbed a piece of pizza and stayed up till one doing case notes, in the OR at seven. That's no way to live. we're asking these people to provide us care. Terry Coutsolioutsos/RevRx AI: Or or or to give your best the following day as well too, right? Like it's not just a living but it's just, you know, like your body does need to rest and it needs to recuperate and you know, like, you know, to give your best you you need to to rest a little bit too and turn your mind and your body off. ⁓ John: Correct. that's what happens with fibromyalgia patients. They can't rest. What a vicious cycle. mean, it's a big part of the ⁓ Terry Coutsolioutsos/RevRx AI: Right. this so this patient acquisition process that you have, you actually did the interview of the ninety minutes. So that that takes part of that hardship away from the clinician too, I'm guessing, along the way, like when you're when you're acquiring those patients in the door, is there a process around that or does that still happen with the clinician, the intake? John: ⁓ no, we have a PA or an MA will handle that. ⁓ A nurse actually, nurses are qualified to handle that, but ⁓ ⁓ have a nurse do the patient input, the follow on appointment where we start to look at what care paths we want to start down. That's managed by a PA or an MA, or excuse me, ⁓ nurse practitioner or PA, and then the physician ⁓ them. Terry Coutsolioutsos/RevRx AI: Yeah. Okay. Okay. John: In most states, mean those, you know, we need to involve the physicians who have oversight and everything and obviously our goal is, our definition of success is a little bit different. We actually want to see how many of them we can roll out at the end of the equation and we'll keep them going through. Terry Coutsolioutsos/RevRx AI: Okay. So you have a telehealth platform that's a revenue stream, right? Along that line. And then I'm sure the data collection process has a lot of value to, you know, a lot of other stakeholders in in healthcare as well, right? Not just, you know, the the data architecture itself, but pharma, research, all those things. John: Correct. Right. financial institutions tracking these ⁓ ⁓ all that information. Hospitals that information. Businesses, organizations are self-insuring certainly want it. ⁓ A ⁓ lot of are moving towards value-based care where they'll actually come in and say, take all our fibromyalgia patients, you manage them. and make sure you do it well enough to have a profit at the end of the day and everybody's happy. So, you know, all those things are played. One thing you mentioned earlier is the patient acquisition process. lot of that, you know, will be pushing out this content that we create that will be, you know, our assets and hopefully it gets legs because it's good. You know, we benchmarked a lot of this. You know, I would say we benchmarked at least half of the stuff in the space. Terry Coutsolioutsos/RevRx AI: Right. Right. John: a little bit beyond using courier type with no kerning as far as how advanced it was ⁓ as far as being good, engaging, you know, content. So ⁓ do that, but we, you know, we do spend on media to send people into some of the studies that we're running. We have investigators who run studies and ⁓ do this a living. Terry Coutsolioutsos/RevRx AI: Right. John: That help us design experiments to make sure hey, let's go figure out whether or not this works So I mentioned at the beginning The That head-on collision having that challenge getting into bioelectronics And that really you know came full circle with all this when we figured out there are a lot of things out there that work and that could add value and can be stacked on top of each other. put Cymbalta on top of Lyrica on top of an off-label application of Gabapentin ⁓ hope for the best. ⁓ ⁓ can ⁓ that there's some interesting things happening with red light therapy and its ability to increase ATP production. So without getting into the technical details, ATP is the Terry Coutsolioutsos/RevRx AI: Right. John: is the little batteries that run your cells. Very important. It's part of that process. We need them when we're healing. We need them when we're trying to overcome challenges with our immune system and things like that. We need them if we've got issues with diabetic neuropathy that can reduce inflammation very quickly. It's keenly interesting. So we'll some people towards those studies. and getting them into those studies you know, gives us the opportunity to tell people what we're doing and why we're focused here. And then we're in six states. We'll roll out sequentially in a phased approach across those six states. We're headquartered Indianapolis and great environment be in telehealth care from. and also favorable tax rate. So that all worked out. But that gives us the ability to really scale this. I we can scale geographically. sales numbers are hundreds of millions of dollars. As far as the number of people who will be employing 125 or 35 nurses in four or five years. Terry Coutsolioutsos/RevRx AI: Right. John: and then scale up from there. So it's a pretty significant opportunity to scale and we've got everything we need to do to do it efficiently. And having those two revenue streams certainly helps. Terry Coutsolioutsos/RevRx AI: Absolutely. And you know, that's the business model part of it, but you know, going back to the friction you're removing is, you know, an access to information for a patient that's really challenged with finding a solution, right? A lot of pain, losing sleep, not feeling well, you know, missing work, not being able to take care of families. That's a that's there's a lot of friction in your in the patients' lives as well. sounds like clinicians are continuously sort of guessing what treatments to And how to diagnose and what to do for what specific treatment. So another great place for clinicians to collaborate, by the way, as well, right? and then since you're gonna be data foundation based, you'll be able to do a couple things with the data. Number one is you know, measure what works and what doesn't work in certain situations and having that large data architecture will allow you to do that. And then you're building, you know, an asset with data that and I'm sure that there are lots of ⁓ institutions in America, whether they are on the drug side, the healthcare provider side, the insurance side, that all would find the information you're creating of value. So like what a great business model clinically providing, data providing, and taking care of patients at the same time. Sounds like everybody's kind of a winner in the ⁓ in the ecosystem. John: God, from your lips to God's ears, Terry. you're absolutely correct. mean, we have a secondary market for the information. Obviously, all of it is no patient information. It's all here from HIPAA. But the informatics we derive from it have almost, you they have value also. So here's what we learned. Terry Coutsolioutsos/RevRx AI: Sure. John: from this information can be really important. But, you know, we want to do a great job providing patient care and we go at it from a little bit of a different perspective because our emphasis is not necessarily where the healthcare systems emphasis is. And we all have deep understanding of systems thinking. mean, this is gaggle of engineers, software developers, statisticians ⁓ analysts that work on this stuff at behest of an issue. ⁓ Terry Coutsolioutsos/RevRx AI: Well, you're you're building yeah. Yeah, you're you're creating access to healthcare that ⁓ you know, again, just there's so many specialties in our healthcare environment today that as you stated earlier, take months and months and months to get access to. And now they can go online and get on a platform and have engagement within twenty four hours. So, you know, that's a big relief because just being able to talk to somebody is ninety percent of the psychology game versus having to wait six months and not find out anything while you're suffering with pain and and sleeplessness. So, ⁓ you all those things kind of play in the wells feed to care, access to care. you know, what a great story. And I'm just I feel privileged to to meet you today and and ⁓ you know, we wish you and and Rapha nothing but the best. And if there's anything that we can do from a zero friction or A Rev RXAI perspective, we're here to help. John: Terry, I appreciate it immensely. It was really good to have a conversation and you drew out some interesting thoughts along the way. So absolutely, we'll be reconvening and I appreciate the time. Terry Coutsolioutsos/RevRx AI: Great, thank you, John. Good luck to you.