Brian Bell (00:01:02) : Hey, everyone, welcome back to the Ignite podcast. (00:01:04) Today, we’re thrilled to have Ryan Eder on the mic. (00:01:06) He is the founder and CEO of Lena Health, (00:01:09) a virtual musculoskeletal and physical therapy company paired to licensed (00:01:12) clinicians with an AI powered web AI assistant to expand access, (00:01:17) improve engagement and modernize how PT actually gets delivered. (00:01:19) Thanks for coming on, Ryan.
Ryan Eder00:01:20 Thanks for having me. (00:01:21) Appreciate it.
Brian Bell00:01:21 I would love to start with your origin story. (00:01:23) What’s your background?
Ryan Eder00:01:24 Punchline is designer turned healthcare entrepreneur, (00:01:27) but I’m from Ohio, (00:01:28) born and raised in Cincy. (00:01:29) I’m in Columbus, but been in Ohio my entire life. (00:01:32) Kind of a nerd growing up, like to draw more than I like to play sports. (00:01:36) Used to like get comic books and just draw and have been like watch like Saturday (00:01:40) Night Nick, (00:01:41) like growing up and all. (00:01:42) And then wanted to get into do something with drawing for school and ended up going (00:01:47) to UC for design architecture, (00:01:50) art and planning college of design architecture. (00:01:52) architecture and planning for industrial design product design so where basically (00:01:56) you start creating something and turn that to life and turn products so i started (00:02:00) creating products after i graduated and that’s actually where the origins of lana (00:02:05) started
Brian Bell (00:02:05) That’s amazing so what did design teach you about human behavior and (00:02:12) interaction that most healthcare operators miss
Ryan Eder (00:02:14) I mean, design is really at its core about empathy. (00:02:17) And so just understanding the world through someone else’s eyes and getting trained (00:02:23) to take complex problems, (00:02:24) break them down into solvable chunks, (00:02:27) and then reconnecting those in a way that can solve a problem in a simple, (00:02:32) intuitive way. (00:02:33) And so I think it’s... (00:02:35) A lot of people, (00:02:35) even just entrepreneurs, (00:02:36) get kind of really fixed on a single path of what they want to build, (00:02:39) what they want to put out there. (00:02:40) And design kind of lets you kind of take a step back, (00:02:43) see what’s going on, (00:02:44) evaluate it as objectively as possible, (00:02:46) and then make pivots or change accordingly. (00:02:48) And we’ve certainly done that all.
Brian Bell (00:02:50) So when was the first moment you realized that MSK and PT were both a broken (00:02:54) experience, (00:02:55) not just a boring category?
Ryan Eder (00:02:56) It’s interesting because this all started from my senior thesis in design school 20 (00:03:01) years ago in 06. (00:03:03) And so it actually started through the lens of, (00:03:05) I saw a guy in a wheelchair struggle while exercising. (00:03:08) And so it started as a concept for accessible, (00:03:10) a piece of accessible fitness equipment that evolved over the years. (00:03:14) But when I was doing the early research with that, (00:03:17) I was playing wheelchair football, (00:03:19) trying to get kind of like just immersed into that world. (00:03:21) And I fell out the back of the chair, hit my back. (00:03:25) And that actually started about a 10 year journey of like rehab. (00:03:29) Like I herniated a disc, aggravated it. (00:03:31) Yeah. (00:03:32) And I was doing, (00:03:32) I was doing the project for a while, (00:03:34) like bedridden and just couldn’t get out, (00:03:36) just do the injury. (00:03:36) And I mean, I (00:03:37) Heard it multiple times throughout subsequent years and went to a lot of physical (00:03:42) therapy, (00:03:43) did a lot of treatment. (00:03:44) It was fantastic. (00:03:45) But you also realize how hard it is to stay consistent with physical therapy. (00:03:49) When it’s in the middle of the day, (00:03:51) you got to go to the clinic, (00:03:53) you got to take off time off work or get family. (00:03:55) It’s just really challenging access. (00:03:56) And that was really kind of the first eye-opening experience of how valuable (00:04:00) physical therapy is, (00:04:00) but how hard it is to access.
Brian Bell (00:04:02) Yeah. (00:04:03) And so was this before or after Include Health?
Ryan Eder (00:04:05) This was, this was the creation of include health. (00:04:08) So yeah. (00:04:10) So what happened was it was my, it was my senior thesis, three month project in school. (00:04:15) And I just wanted to have a kick-ass thesis to graduate, get a job, call it a day. (00:04:19) So I saw this guy in a wheelchair struggle, (00:04:21) came up with this concept for accessible piece of fitness equipment that like (00:04:24) anybody could use. (00:04:25) It’s like, if you’re in a wheelchair, if you, you know, (00:04:27) standard, the dexterity issues, that kind of thing. (00:04:29) And so I did it. (00:04:31) I graduated. (00:04:32) I moved up to Columbus, (00:04:33) started working as a product designer for a design firm on the east side of town, (00:04:36) priority. (00:04:37) And I decided to enter the thesis into the International Design Excellence Awards (00:04:41) competition, (00:04:41) which is like a global competition for design firms, (00:04:44) corporations. (00:04:45) They have like a little student category, proud of it, figured why not. (00:04:48) Ended up winning gold, best in show and people’s choice. (00:04:50) And I think it was like 1,700 entries from 35 countries. (00:04:55) And it rocked my world. (00:04:57) And so that got a lot of eyes on this idea of this machine. (00:05:01) And I was able to parlay that into getting some kind of some grants to kind of push (00:05:05) the idea further. (00:05:06) I moonlit it for seven years, (00:05:08) just doing nights and weekends, (00:05:09) kind of just tinkering with this idea. (00:05:12) to where I ultimately was able to start raising some venture capital to start (00:05:15) building the machine. (00:05:16) And I think the first dollars we raised were in 12 or 13.
Brian Bell (00:05:20) Wow, okay.
Ryan Eder (00:05:22) The interesting thing here is it’s actually the same startup.
Brian Bell (00:05:25) Okay, interesting.
Ryan Eder (00:05:26) Yeah, so I’ll walk you through the kind of evolution here. (00:05:30) I mean, I learned a lot even that first go around. (00:05:32) I mean, back then, (00:05:33) I was a young buck out of school. (00:05:35) The ecosystem wasn’t as mature as it is now to where people weren’t really writing (00:05:39) big checks for first-time founders that are just right out of school, (00:05:42) right? (00:05:42) It was just a very different world then. (00:05:44) So I had to bring on folks to kind of help build around me. (00:05:48) I had to bring on someone to be like an experienced CEO at first to help me raise (00:05:52) those dollars and kind of take a back step to just kind of building the product, (00:05:57) but ultimately became to where I transitioned to CEO just a few years later. (00:06:01) But yeah, the journey.
Brian Bell (00:06:03) You’re like early to mid 20s. (00:06:05) You’re like, I’ll bring in some professionals here to help me. (00:06:08) Yeah.
Ryan Eder (00:06:09) I’ve like, (00:06:10) in my world, (00:06:10) it was, (00:06:11) you know, (00:06:11) I was able to get like a $50,000 grant here, (00:06:14) $20,000 grant there, (00:06:15) which is great. (00:06:16) Right. (00:06:16) But when it came time to like, okay, now you need to raise a couple of hundred thousand dollars. (00:06:20) People are like, I’m not going to give it to you just by yourself to just go build something. (00:06:24) You know, we need to have, you know, I’m out of design school. (00:06:27) We need to have a business plan. (00:06:28) You need to know what the hell you’re doing. (00:06:29) And like, what’s, you know, give me your financial model. (00:06:32) And I didn’t have anything. (00:06:33) clue how to do any of that then right so got some help raised some money built the (00:06:38) first machine or like a physical machine is a 900 pound machine with like a (00:06:42) thousand yeah okay and like we we built it and then i can send the like i said you (00:06:47) a video of this as well like then we built a custom mobile showroom to drive it (00:06:51) around because we knew we couldn’t get people to interact with it coming to us and (00:06:56) so we built this showroom and this was in the beginning of (00:06:58) 2013 we drove it around the eastern half of the us going to like we went to the va (00:07:03) in dc like the national rehab hospital lakeshore foundation down in alabama just (00:07:09) getting people to interact with it and it was at that time as we were doing like (00:07:12) kind of like this two week long tour (00:07:14) The machine was just like mechanically smart. (00:07:17) It wasn’t digitized at all. (00:07:19) And it made a lot of sense talking to these folks like, (00:07:21) okay, (00:07:21) this machine should be smart and should be able to just do simple stuff like (00:07:25) logging your work out, (00:07:26) tracking your progress. (00:07:27) And that’s what started the software that is still the kernel to this day for LANA, (00:07:32) but just in a very different way.
Brian Bell (00:07:33) That’s amazing. (00:07:34) So you start off like on hard mode, it sounds like. (00:07:37) This is not a software tech scalable startup. (00:07:40) It’s a hardware medical device, PT kind of business. (00:07:44) Brutal, brutal.
Ryan Eder (00:07:46) I mean, it was like 35 suppliers. (00:07:49) I had a lot of manufacturing challenges getting it to market. (00:07:51) That tour was in 13. (00:07:53) We didn’t launch it until 18. (00:07:56) And there was a point where pretty sure the company was going to shut down. (00:08:00) We got kind of the... (00:08:02) the bill of materials from all our different suppliers and it completely destroyed (00:08:05) our margins and our pricing. (00:08:08) I mean, upside down destroyed. (00:08:10) And so we actually ended up putting a pause on the company and then restructured it (00:08:16) as the machine plus the software as a platform, (00:08:20) as a service that you could essentially finance over a three-year contract. (00:08:24) And we were able to get that total contract to cover all the costs and everything (00:08:27) else with the machines. (00:08:28) And we launched those in 18. (00:08:30) And so like the very first customer was the Cleveland VA clinic, (00:08:35) their spinal cord injury clinic. (00:08:37) And it was just me and my brother installing this 900 pound machine and putting it in there. (00:08:42) And I mean, it was vision realized because you had like a, (00:08:45) The quadriplegic veteran was the first person to use this machine, (00:08:48) which is why this thing was designed, (00:08:50) right? (00:08:51) And it was a really powerful moment, terrifying moment to leave that machine there. (00:08:55) But that was the start of it. (00:08:57) And then in subsequent years, we started to expand beyond machines.
Brian Bell
(00:09:01) Yeah. (00:09:01) So tell us about that. (00:09:02) So you finally get this machine... (00:09:04) It’s barely covering the costs. (00:09:06) You know, did you have to go through FDA approvals as well to kind of get it?
Ryan Eder (00:09:10) We didn’t have to go through FDA. (00:09:12) We do now. (00:09:12) We didn’t have to do it then. (00:09:14) But we had these, I mean, you got to make sure that it’s safe, right? (00:09:17) So like you’re engineering it. (00:09:19) And I was part of this ASTM standards committee where it’s all about usability. (00:09:22) And so it was like we had these design parameters where it’s like I need (00:09:27) You’ll be able to adjust everything with a single arm, (00:09:29) closed fist and less than seven pounds of force. (00:09:32) Meanwhile, you need to be like UL safety standards, like a three X safety rating. (00:09:37) So there was like, for example, there’s a seat. (00:09:39) that you need to be able to adjust for those parameters, (00:09:42) but you needed it to support a 300 pound person, (00:09:45) which means it needed to support 900 pounds. (00:09:47) So, (00:09:47) I mean, (00:09:47) the thing was an engineering tank that you could adjust just, (00:09:51) you know, (00:09:51) by a single finger or close fist kind of deal. (00:09:54) So there was a lot of that going on, (00:09:56) but figured it all out, (00:09:58) got it out, (00:09:59) installed it, (00:09:59) started installing them in 18. (00:10:01) And then in 19, (00:10:03) we ended up, (00:10:04) I mentioned I’m in Ohio, (00:10:05) we ended up doing a partnership with Cincinnati Children’s Hospital. (00:10:08) And they had been developing some computer vision technology and interfaces for, (00:10:14) you know, (00:10:14) injuries, (00:10:15) specifically ACL injuries for female athletes. (00:10:18) They had gotten like 10 million in like NIH dollars and all, (00:10:21) and they were looking to commercialize it. (00:10:23) And they said they thought they could leverage kind of our platform that we built (00:10:27) to kind of accelerate that. (00:10:29) we ended up partnering with them in 19 and then in early 20 like we saw the machine (00:10:35) and we knew what it could do and when we installed it in 18 people like i like this (00:10:39) but i have a bunch of other like dumb equipment around here now i want this all to (00:10:43) be smart you’re like okay well i’m never building another machine ever again like (00:10:46) that was just a horrible experience i was like i can take the brains out of our (00:10:51) machine and into a sensor and (00:10:53) connect these other machines. (00:10:54) So like we started piloting it with health partners up in Minneapolis, (00:10:57) C&C, (00:10:58) and then the Air Force as well. (00:10:59) And then we debuted it in February, (00:11:02) these sensors that were basically the expansion of our machine. (00:11:04) We debuted those in February of 20 at a big PT conference right before COVID hits.
Ryan Eder (00:11:10) right so yeah perfect and so covet hits no one gives a about smart machines when (00:11:17) you can’t get people in the clinic in the first place so we’re sitting there and of (00:11:21) course as soon as it hits no one knows is this two weeks is this two years like (00:11:24) what’s what’s happening here but it was clear that everything machine based was on (00:11:28) pause and so then i (00:11:30) Went to the board and said, I think we need to shift gears. (00:11:34) We just did this deal to get us into computer vision. (00:11:36) I think we need to shut down the machine side of the business to stay alive and go (00:11:41) all in on computer vision to not deliver care in a clinic, (00:11:44) but to deliver care in patients’ homes. (00:11:46) At that point, again, that was 2020. (00:11:48) My thesis was 2006. (00:11:50) So I spent all that time getting these machines developed and built out. (00:11:54) Yeah, 14 years. (00:11:55) And it’s like, all right, let’s shut her down. (00:11:57) And I’m the one that...
Brian Bell (00:11:57) Two years of your entire working life, your entire career at that point.
Ryan Eder (00:12:02) And that goes back to that whole... (00:12:05) That goes back to that whole designer mindset, right? (00:12:08) Where it’s like, look, I can see what’s happening here. (00:12:10) Yes, I’ve dedicated all this time to this machine, but this is... (00:12:14) This is a different world we’re navigating. (00:12:16) There’s a different opportunity here. (00:12:17) We can leverage the kernels of the software from the machines to power the computer vision. (00:12:21) And so when we did that, (00:12:23) we decided to basically go as anti-hardware as humanly possible, (00:12:27) learning from the machines and saying, (00:12:29) all right.
Brian Bell (00:12:30) Hardware agnostic, right?
Ryan Eder (00:12:31) I mean, (00:12:32) Yeah. (00:12:32) Well, (00:12:32) at that time, (00:12:33) like the computer vision was still powered by like, (00:12:36) think of like when Microsoft had like the Kinect camera and it had, (00:12:39) it was still hardware. (00:12:40) It was still hardware dependent. (00:12:41) And like Apple was off the shelf stuff rather than your own. (00:12:45) Yeah. (00:12:46) Yeah. (00:12:46) But like Apple, (00:12:47) you know, (00:12:47) was just releasing, (00:12:49) like, (00:12:49) I forget what they called it, (00:12:50) but it had like LiDAR on some of the, (00:12:52) on some of their devices, (00:12:53) but it required a specific camera. (00:12:55) I’m like, (00:12:55) look, (00:12:55) if you’re going to scale this in healthcare, (00:12:58) you can’t require specific hardware. (00:12:59) this thing’s got to run on it so we were we did we had a few different contracts (00:13:05) with the air force through their sbir program and so we were working with them and (00:13:09) they were one of the first ones to test this and so we kind of built it originally (00:13:13) around apple’s vision kit that’s what it was called just to see like you know does (00:13:17) this work with our system that kind of deal and it worked but (00:13:21) You’re not going to limit healthcare deployment just to those that are on Apple devices. (00:13:25) So that wasn’t going to fly. (00:13:26) But then Google had a model at that time called PostNet. (00:13:31) that was a browser based and on everything, wildly inaccurate. (00:13:36) Like you go to like PT, (00:13:37) like anything, (00:13:38) if you’re like laying down, (00:13:39) sitting down, (00:13:39) the model would just blow up, (00:13:41) right? (00:13:41) So I’m sitting there, you know, you’re in the thick of COVID. (00:13:43) I’m like, shit, okay, I need to get this out. (00:13:46) I wanted to run everything, but I needed to be accurate enough. (00:13:48) So I recorded a side-by-side of Apple’s Vision Kit and Google’s PoseNet. (00:13:53) And I shot it to one of the advocates at Google that was posting about kind of (00:13:58) their technology. (00:13:58) I was like, Hey, look, this is what I want to do. (00:14:00) I want to give this to healthcare. (00:14:01) I’ve got the air force teed up to test this, (00:14:04) but your model breaks, (00:14:05) falls apart here, (00:14:06) here, (00:14:06) and here. (00:14:07) Is there anything we can do and collaborate?
Brian Bell (00:14:09) not thinking Google would respond to you.
Ryan Eder (00:14:11) They did respond. (00:14:12) Jason Mayes, shout out to Jason. (00:14:14) We’re still heavily linked with him now. (00:14:17) He got back and said, (00:14:18) actually, (00:14:18) we are developing these models and would love to have a powerful case study and (00:14:23) start training them. (00:14:25) I started like two years of collaboration with Google through COVID. (00:14:28) In 21, we were featured in their I.O. (00:14:30) conference showcasing the evolution of this body tracking technology, (00:14:34) which is at the end of the day, (00:14:36) you know, (00:14:36) you’re estimating joint positions right through through a video feed. (00:14:39) But there’s literally a video of me back here in my office, (00:14:42) like doing these exercises with the dots tracking me and all that kind of stuff (00:14:45) like on Google site and stuff. (00:14:47) And we finally made it where it’s accurate enough for PT, (00:14:50) but scalable enough to run on any device and be web based. (00:14:53) So we piloted it some more at the Air Force, got really strong results.
Brian Bell (00:14:57) And by any device, you mean any laptop or mobile phone?
Ryan Eder (00:15:00) Yeah, anything with a browser and a front-facing camera.
Brian Bell (00:15:03) Okay. (00:15:05) Did you have to send the data to the cloud to actually run the inference or are you
Ryan Eder (00:15:09) that happened locally in the browser. (00:15:11) Okay. (00:15:11) So yeah, it’s nice. (00:15:12) Yeah, it’s nice. (00:15:13) So the model, (00:15:14) like they had two different versions of the model, (00:15:16) like thunder and lightning is what they call it internally. (00:15:18) And it would download that model upfront. (00:15:22) And so you don’t have a little bit of a buffer. (00:15:24) So you kind of give them like the patience, (00:15:25) the overview of what they were going to do while it downloads that model. (00:15:28) But once it downloads the model, that was the power of the tech. (00:15:30) It all ran locally.
Brian Bell (00:15:32) So it’s basically running on CPU hardware.
Ryan Eder (00:15:36) Super light, super light. (00:15:38) And there was a point in time where we were testing the boundaries of the devices. (00:15:43) I had like 40 devices here. (00:15:45) It’s like any screen size, any browser, any OS version, right? (00:15:49) And then phone, tablet, laptop. (00:15:52) Like, oh my gosh, how do you get your arms around it? (00:15:55) So we’re like testing all of these and like it, (00:15:57) it worked on everything except for the Amazon fire tablets. (00:16:01) That’s where, that’s where it broke down like a $50 tablet kind of thing.
Ryan Eder (00:16:05) Like it just wasn’t powerful enough.
Ryan Eder (00:16:07) But like the key for the experience was to have no latency. (00:16:11) So that’s where like the cloud stuff wouldn’t work is even a slight latency just (00:16:15) destroyed the experience. (00:16:16) And so it had to be real time, but run on anything. (00:16:20) So we built it.
Brian Bell (00:16:21) I’m kind of skipping ahead here, (00:16:22) but like we’re sitting here in 2026, (00:16:24) you know, (00:16:25) years later, (00:16:25) I’m guessing the phone hardware is a lot more powerful now and you can run a lot (00:16:29) better models locally.
Ryan Eder (00:16:30) Don’t need it. (00:16:31) So the, (00:16:32) a lot of people get caught up on, (00:16:33) there’s like a whole conversation in this about like 2d versus 3d data and what (00:16:38) you’re getting. (00:16:39) And oh, (00:16:39) if you got more powerful devices, (00:16:41) you can get more powerful data in our world where you’re delivering physical (00:16:44) therapy. (00:16:45) You’re really just trying to get people to move.
Brian Bell (00:16:47) Just tracking the joints. (00:16:49) And there’s like an asymptote of quality and accuracy there, right? (00:16:52) Right.
Ryan Eder (00:16:53) Like, (00:16:53) I mean, (00:16:53) you can get into the weeds of like, (00:16:55) well, (00:16:55) is this plus or minus two degrees versus three degrees? (00:16:58) And like that kind of thing. (00:16:59) That doesn’t matter. (00:17:00) At some point it’s like good enough. (00:17:01) And like, (00:17:01) you’re just eking out like little, (00:17:03) little points of classification F1 score or whatever. (00:17:06) Exactly, exactly. (00:17:07) So the thing is, (00:17:08) like, (00:17:08) when you’re treating patients with PT, (00:17:10) I mean, (00:17:10) we’re treating patients from their teens to their 90s. (00:17:13) So like you got such a wide spectrum of demographics and cases, (00:17:18) both post-op and chronic patients. (00:17:20) And so you need to make that technology as simple as humanly possible, right? (00:17:25) And run on anything. (00:17:26) So I mean, we’ll run on devices that are 10 years old, it’ll still run. (00:17:30) And so (00:17:31) What was interesting is that we originally built all this not for us to treat (00:17:36) patients directly. (00:17:37) So this was all built to hand to the industry to use in like hybrid care and (00:17:42) virtual care and like remote therapeutic monitoring was the reimbursement model (00:17:46) that came in through CMS. (00:17:49) I think it launched in 22. (00:17:51) And we thought that was the godsend. (00:17:53) We’ve got a reimbursement model to treating patients virtually. (00:17:55) We’ve got this technology. (00:17:56) We’re going to work with the industry, give them this, and then we’re going to be on our way. (00:18:00) And that wasn’t the case, of course.
Brian Bell (00:18:02) So what does in this case, clinician plus web AI actually mean in practice? (00:18:06) Walk us through kind of the patient experience.
Ryan Eder (00:18:08) And to give you the quick context is like, (00:18:11) we did it with RTM for the industry for almost two years.
Brian Bell (00:18:14) What’s RTM?
Ryan Eder (00:18:15) Remote therapeutic monitoring. (00:18:16) So it’s a reimbursement model from the payer CMS started. (00:18:20) The commercial payers did it afterwards that you could get reimbursed for remotely (00:18:23) monitoring these patients. (00:18:24) Getting it out into the industry was really challenging. (00:18:26) With the patients we got on it, fantastic engagement results. (00:18:30) Getting enough patients on it at the pace we wanted to was not happening. (00:18:33) And so we actually... (00:18:35) really hard for a PT and a clinic to change their operating model on a dime. (00:18:41) The industry is dealing with a lot of issues from just overall reimbursement and (00:18:44) what it means of your day-to-day in the clinic and documentation. (00:18:47) And now you want to add that, like it was just, you’re just taxing everybody. (00:18:51) And so we saw that. (00:18:54) And then we were working with a couple of care navigation companies and they saw it (00:18:58) too and said, (00:18:59) we need more people on your deck. (00:19:01) Would you consider treating patients directly?
Brian Bell (00:19:03) And you’re like, okay, so this is summer of 23. (00:19:05) And you’re like, now we’re considering becoming a virtual medical practice. (00:19:10) Right, and you don’t have anybody on staff that can technically deliver care, right?
Ryan Eder (00:19:15) Actually, I did.
Brian Bell (00:19:16) Okay, nice, all right.
Ryan Eder (00:19:17) Yeah, (00:19:17) and that’s the only reason it made it feasible was that I had some PTs on staff (00:19:21) that were more of like ClinOps helping other PTs, (00:19:23) but that were licensed in a large amount of states. (00:19:26) I was like, all right, we can try it. (00:19:28) And so we started trying this in summer of 23. (00:19:31) And now to your question about the model of how this works is, (00:19:33) I mean, (00:19:33) it really at its core is we’re pairing licensed clinicians with a web-based AI (00:19:38) assistant. (00:19:38) Her name’s Laina, right? (00:19:40) And so the way that this works is...
Brian Bell (00:19:40) Or Laina, if you’re from Hawaii, as we discussed.
Ryan Eder (00:19:45) If you’re from Hawaii, you can pronounce it Laina as well. (00:19:49) The way that it works on one hand, (00:19:50) it’s very similar to like traditional physical therapy, (00:19:52) meaning that like we’re an integrated medical model. (00:19:56) So that means we work directly with referring physicians, (00:19:59) primary care docs, (00:20:01) orthopedic specialists. (00:20:02) So they are prescribing physical therapy like they would for anyone else. (00:20:05) The difference is that they get prescribed virtual. (00:20:08) And so we get a referral that comes our way. (00:20:10) I mean, (00:20:11) This is old school healthcare. (00:20:12) We’re talking faxes, right? (00:20:14) Come to us.
Brian Bell (00:20:15) Literally faxes? (00:20:18) Right now, like in the last month, you got a fax?
Ryan Eder (00:20:21) I bet you we got a lot of them today.
Brian Bell (00:20:23) Oh, wow. (00:20:24) That’s amazing. (00:20:25) That’s crazy. (00:20:26) What are we doing?
Ryan Eder (00:20:28) Healthcare change is really tough for a lot of reasons, right? (00:20:33) And that’s one of the challenges and kind of the part of this journey here, right? (00:20:38) But you got to operate within this existing system. (00:20:40) At least we think that’s the right approach. (00:20:42) And then, but we get these referrals. (00:20:44) But that’s where everything changes. (00:20:45) So instead of like you getting this referral and you’re going to go call a clinic (00:20:49) and schedule something, (00:20:50) right? (00:20:51) We shoot you a text. (00:20:52) It is a self-scheduling link. (00:20:53) Just pull up here, one tap access. (00:20:55) And then you schedule your virtual visit with a dedicated PT on our staff. (00:20:59) Hop on it. (00:21:00) It’s all web-based. (00:21:00) So no one’s going to download anything even for like the virtual visits and all.
Ryan Eder (00:21:03) And so you meet your PT, you have a 45 minute session, like here’s what’s going on, right? (00:21:08) Here’s what I’m trying to do. (00:21:09) And then that PT creates this custom care plan, digital care plan based on that eval. (00:21:14) And then that’s where Elena helps out. (00:21:16) So then Elena comes in and is going to send you kind of daily reminders when you (00:21:21) have something prescribed for you to do. (00:21:22) Sometimes it’s stretches, sometimes it’s exercises, functional tests, some surveys, right? (00:21:27) It kind of just depends on the care plan structure. (00:21:29) But she sends you this SMS reminder that has a tokenized secure link. (00:21:34) So you just tap that link. (00:21:35) It opens up the browser. (00:21:37) We’re HIPAA compliant. (00:21:38) We’re a class two registered device with the FDA, (00:21:40) but you don’t have to download it and then you don’t have to log in. (00:21:42) That’s just all barriers of friction for a lot of folks, right? (00:21:44) One tap, you’re in. (00:21:46) You kind of get an overview of what you’re going to do and you hit start. (00:21:49) Sometimes you’re in front of the camera doing computer vision tracked activities. (00:21:52) Sometimes you’re responding to evidence-based surveys just to track kind of how (00:21:56) you’re progressing. (00:21:57) But what that does is LENA is basically the extension of the treating PT. (00:22:02) So now patients are able to do it when it’s convenient for them. (00:22:05) You have to take time off work. (00:22:07) They can do it after the kids go to bed, right? (00:22:09) Whenever it fits into their schedule. (00:22:11) But we collect all this data. (00:22:13) thing goes right back to the treating pt there is secure messaging between the pt (00:22:18) and patient throughout the entire time and so like if you need anything like oh (00:22:21) this hurts or i wish you could do this just ping them and they get back to you and (00:22:24) update you don’t have to wait till the next time you’re in the clinic then the pt (00:22:27) and the patient basically have a face-to-face visit once a month the rest is all (00:22:31) done async and monitoring the net result there is like an average pt episode gets (00:22:36) about eight visits we get 34
Brian Bell (00:22:40) So what is a PT episode?
Ryan Eder (00:22:42) So PT episode is how long from start to finish you’re in care.
Brian Bell (00:22:45) So you go and you started your care treatment and when are you deemed discharge, you’re done.
Ryan Eder (00:22:49) And so in traditional PT, (00:22:51) you know, (00:22:51) they want you to go to the two to three times a week, (00:22:54) every week that never really happens. (00:22:55) You know, statistically it’s about the average is about eight visits, eight in clinic visits. (00:23:00) Now for us, (00:23:01) The average number of visits, (00:23:03) this is both in clinic or in face-to-face, (00:23:05) but also like doing sessions on the app and tracking your progress. (00:23:08) So that’s synchronous and asynchronous. (00:23:11) That’s 34. (00:23:12) At the end of the day.
Brian Bell (00:23:13) So basically like a 4x uptake of sessions.
Ryan Eder (00:23:15) Correct. (00:23:16) Correct. (00:23:17) And at the end of the day, (00:23:18) it’s as simple as if you can make care more convenient for patients, (00:23:21) they’re going to do it. (00:23:23) The chances are they’re going to go higher. (00:23:24) If they do it, (00:23:25) chances are they’re going to get better outcomes because they’re actually engaged (00:23:28) in their care. (00:23:28) And then you leverage technology to validate those outcomes. (00:23:31) So there’s no guessing. (00:23:32) So it’s really just yet another example of AI making leverage in our economy where, (00:23:38) you know, (00:23:38) previously I had to, (00:23:39) you know, (00:23:40) get in my car and drive down to the PT office three times a week, (00:23:43) which I didn’t do. (00:23:44) Maybe I went once a week. (00:23:45) And then I’m supposed to do it at home, right, on my own. (00:23:48) Maybe I’m doing that or not doing it. (00:23:50) But now I can click this link, (00:23:52) get this AI feedback, (00:23:53) instant feedback on the exact exercises I should be doing. (00:23:57) And now every PT is, you know, three to four times more efficient in delivering care.
Brian Bell (00:24:02) Because am I still meeting with a PT every week just to check in? (00:24:05) Or is it just like the one and done?
Ryan Eder (00:24:07) You have once a month for the face to face. (00:24:09) We also offer twice a month if you need it, but usually it’s once a month and the rest is done.
Brian Bell (00:24:12) I mean, you’re talking like a X more efficient delivery of care.
Ryan Eder (00:24:17) At least, at least.
Brian Bell (00:24:19) And when you guys go direct to the consumer here, (00:24:23) direct to the patient, (00:24:24) that means, (00:24:25) you know, (00:24:25) your margins go way up compared to a regular PT office.
Ryan Eder (00:24:28) Without a doubt. (00:24:29) Yeah. (00:24:30) Without a doubt. (00:24:31) And to that point, (00:24:32) we have healthy margins, (00:24:33) but we are an entire episode of us from start to finish is typically less than a (00:24:38) single in-person eval. (00:24:39) So we on a blended weighted average are saving 74% in care delivery through this (00:24:45) model without compromising patient outcomes or patient satisfaction.
Brian Bell (00:24:49) So payers love you, right? (00:24:50) So now payers are sending more business your way because you can charge less, right? (00:24:55) For a unit of care.
Ryan Eder (00:24:56) Absolutely. (00:24:58) Materially.
Brian Bell (00:24:59) A higher margin than the traditional PT.
Ryan Eder (00:25:02) Also true. (00:25:03) And while that patient feels more supported, is more engaged, they’re engaged in their care. (00:25:08) That also means you’re preventing more downstream, (00:25:10) higher cost interventions because they are actually engaging in lower cost care up (00:25:15) front. (00:25:15) Right. (00:25:16) And so you’ve got kind of that trifecta of the cost savings, (00:25:19) the high engagement, (00:25:21) the equivalent outcomes through this just by... (00:25:26) you know, supercharging a clinician with AI.
Brian Bell (00:25:28) Are there any kinds of PT that are kind of edge cases that you guys don’t cover? (00:25:33) They just need-
Ryan Eder (00:25:33) Oh, for sure. (00:25:34) Yeah. (00:25:34) Yeah, for sure. (00:25:35) So like, and just even at the highest level, we’re not trying to replace in-person PT. (00:25:40) So there’s a large collection of cases where you can only treat in person. (00:25:45) Right. (00:25:45) There’s also patient preference, (00:25:47) but like the cold reality in the PT industry is a vast majority of patients (00:25:51) prescribed PT. (00:25:51) Don’t go like only 20 to 30% actually go because of these access.
Brian Bell (00:25:56) Yeah. (00:25:57) I’ve had lots of basketball injuries over the years. (00:25:59) So I’ve done, I’m very familiar with PT. (00:26:01) Yeah. (00:26:02) Lots of sprains and ankle sprains and knee sprains and my old grade one tears of my (00:26:07) MCL, (00:26:08) ACL and stuff like that, (00:26:09) meniscus. (00:26:10) So very familiar. (00:26:11) I feel like it was once or twice a week and then they’d give you kind of home exercises to do. (00:26:15) I didn’t have AI watching me and giving me feedback for sure.
Ryan Eder (00:26:17) Right. (00:26:17) Right. (00:26:18) Or even like our patients will say they feel more connected with their PT because (00:26:20) they can message them at any time and get back to them. (00:26:22) Right. (00:26:23) Right. (00:26:23) But like exercise, right. (00:26:25) Like a little recording kind of thing. (00:26:26) And Hey, pain just spiked here. (00:26:27) Can you adjust my care plan? (00:26:29) You know, accordingly, like boom, it’s done. (00:26:31) But to your question also, like the, from a, from a patient standpoint, like,
Brian Bell (00:26:35) Well, another question I had here was like, where does it create leverage? (00:26:39) It sounds like it’s an engagement, you know, personalization, but the tracking and feedback.
Ryan Eder (00:26:46) It gains leverage kind of throughout the whole workflow. (00:26:49) So like, (00:26:51) if you think of the average wait for PT can be three to six weeks or typically one (00:26:56) week. (00:26:57) You make the care more convenient for the patient. (00:26:59) Obviously, there’s the upside there. (00:27:00) They’re engaged. (00:27:01) They get the outcomes. (00:27:01) We measure these outcomes. (00:27:03) The industry actually has a really hard time measuring outcomes in a centralized, (00:27:06) standardized way. (00:27:07) So the payers love it because it’s not only are you getting the economic impact, (00:27:11) but you can give them exactly visibility of what’s going on. (00:27:14) right? (00:27:14) And so just full transparency there. (00:27:16) And so it is really kind of a win-win across the stack, (00:27:19) the challenges scaling in healthcare and a pace at which that, (00:27:23) you know, (00:27:23) the uptake there, (00:27:24) which is what, (00:27:25) you know, (00:27:25) we’re focusing on next, (00:27:27) but the model just works end to end. (00:27:29) And to your question earlier, the, but it’s not appropriate for everybody. (00:27:33) So meaning that like, (00:27:34) we don’t treat patients that, (00:27:36) you know, (00:27:36) have neurological deficits as it’s harder for them to navigate technology into (00:27:40) Independently, (00:27:41) we don’t treat those that have high fall risk because you certainly want someone (00:27:44) there in the event they do fall. (00:27:46) And so always with our partners, we have like an inclusion exclusion criteria list. (00:27:51) So referrals can come in. (00:27:52) Sometimes they have a diagnosis like, hey, we can’t we can’t treat that and defer them back. (00:27:55) There’s so much patient risk here. (00:27:58) 100%, right? (00:27:58) And then even that, sometimes patients will come in, looks good on paper, you do the eval. (00:28:03) This is why it’s so critical to have that first eval with that, like your licensed PT. (00:28:08) And then they make that determination whether or not virtual is appropriate for you. (00:28:11) So we want to make sure that you’re doing as cliche as it is the right care at the (00:28:15) right time and place. (00:28:16) But our whole goal is to capture all those patients that need PT, (00:28:20) but just can’t make the legacy model work.
Brian Bell (00:28:22) How do you think about the size of the market for that?
Ryan Eder (00:28:25) It’s, I mean, it’s, what was it, like 35 million people access PT a year in the U.S.? (00:28:30) I mean, (00:28:30) from a musculoskeletal condition, (00:28:32) one and two adults statistically have, (00:28:34) I mean, (00:28:34) we’ve all got aches and pains to talk about from your basketball injuries, (00:28:37) my back, (00:28:37) my elbow, (00:28:37) my shoulder. (00:28:38) I mean, the older you get, the worse it gets, right? (00:28:40) Right. (00:28:40) So, and, you know, MSK, you know, surgery specifically are one of the top spends in healthcare. (00:28:47) And so the market is massive. (00:28:50) And, (00:28:50) you know, (00:28:50) you’ve got companies that have been in this space delivering digital services for a (00:28:55) while. (00:28:55) Some of them have gone public this past year in 25. (00:28:59) but they have roughly like 1% of the market, which tells you just how big it is. (00:29:05) So there’s a lot of different, (00:29:06) there’s a lot of room for different approaches all in the name of just making more (00:29:10) entry points to access care.
Brian Bell (00:29:13) That’s pretty, pretty amazing. (00:29:14) And you seem to believe that clinician led with AI augmentation wins versus purely (00:29:19) automated models.
Ryan Eder (00:29:20) I’m not, I’m not alone there. (00:29:21) There’s been a lot of studies that have shown, like, I think, you know, (00:29:25) people get overly excited about technology and, (00:29:28) you know, (00:29:29) swing too hard and then end up like saying, (00:29:31) oh, (00:29:31) well, (00:29:32) technology could do everything. (00:29:33) And then they would do these studies and he’s like, (00:29:35) well, (00:29:35) these patients aren’t really engaged in their care when it’s just, (00:29:38) just the tech kind of deal. (00:29:40) So there’s, (00:29:42) In any kind of care delivery, (00:29:43) human recovery, (00:29:44) there’s just a very human element behind it of like, (00:29:47) there’s a comfort level of knowing there’s a licensed clinician human on the other (00:29:52) side that understands your discrete case and is there to help you more than like (00:29:57) putting you in like a generalized playlist bucket of some tech.
Brian Bell (00:30:01) Yeah. (00:30:01) What’s your, so what are your limits to growth here? (00:30:03) Like you need to basically have a PT who’s licensed in each state or can one PT get (00:30:08) licensed in multiple states or some other kind of levers and limits of growth here (00:30:12) for you?
Ryan Eder (00:30:13) From a licensure standpoint, you know, we’re in 45 states right now. (00:30:17) that’s not easy you’re right you have to get licensed in all these different states (00:30:20) different states have different methods some very uh modern some snail mail asking (00:30:27) for documentation from the pts you know previous five employers and their place of (00:30:33) education like so you know there’s that layer to it but that’s all solvable right (00:30:37) we’re almost got all 50 there you then get into (00:30:40) We believe our approach is to be integrated into the existing system. (00:30:44) So there’s a lot of another approach that companies have done is going through like (00:30:49) employers and being part of like their wellness benefits, (00:30:52) if you will. (00:30:52) And I understand that path because you’re not kind of going through the industry (00:30:57) sludge, (00:30:57) right, (00:30:58) to get there. (00:30:58) But if you look at it, (00:31:00) they’re usually spending about 50 cents every dollar on marketing to these (00:31:04) employees and to these members about this benefit you may have. (00:31:08) Humans in the U.S. (00:31:09) access healthcare through their local provider networks, through their PCPs, through their docs. (00:31:14) That’s where they go. (00:31:15) Yeah, (00:31:15) they’re going to go to their family doctor, (00:31:16) and the doctor’s going to say, (00:31:17) yeah, (00:31:18) some PT is warranted here. (00:31:19) Or maybe they send you to a radiologist, and you get an x-ray. (00:31:22) Right, but it’s still your local network, right? (00:31:26) I think it’s statistically over 95% of people. (00:31:29) That’s where they start the entry point. (00:31:30) That’s where I’ve always gone for PT. (00:31:32) I’ve never done the virtual thing. (00:31:33) Me too. (00:31:34) Me too. (00:31:34) So we want to focus there. (00:31:36) So we want to focus where the 95% are. (00:31:38) Now what that means...
Brian Bell (00:31:38) So you got to settle the payers. (00:31:40) That’s your distribution strategy. (00:31:42) It’s kind of convinced the payers here that...
Ryan Eder (00:31:42) It’s a crowd for stack. (00:31:45) So like, (00:31:46) and this is what makes it so hard in healthcare when you want to have it be an (00:31:49) integrated model. (00:31:50) But I think this is the ultimate approach that’s going to win. (00:31:52) So you need to have the payer aligned, but then you’re in the provider network. (00:31:56) We’re getting referrals from PCPs, orthopedic surgeons. (00:31:59) So they need to know about you, be comfortable with you. (00:32:02) And then they present it to the patient. (00:32:03) And that patient, when they’re like, here, you know, we want to prescribe virtual PT. (00:32:08) What the hell is that? (00:32:09) Yeah. (00:32:09) There’s an automatic probably discount in the consumer mind here. (00:32:12) Like, are you trying to like shovel me off to like some software AI thing? (00:32:17) Right. (00:32:17) Like, (00:32:17) are you going to, (00:32:18) like most people think it’s either going to be like pure, (00:32:20) like telehealth visits, (00:32:21) right? (00:32:21) The whole time or like YouTube videos. (00:32:25) and just free for all. (00:32:26) And so like there’s an education that goes across kind of all those. (00:32:29) And then we build up these case studies and (00:32:33) When you can align all that, (00:32:34) that’s when you really start to unlock what this can do, (00:32:37) but that takes time and not everybody, (00:32:39) you know, (00:32:40) has that kind of time.
Brian Bell (00:32:41) Yeah. (00:32:41) It’s a, (00:32:41) it’s a multifaceted problem where you have to sell lots of different constituents (00:32:45) at different layers of healthcare stack all at once. (00:32:48) But it probably creates a little bit of a moat, which was going to be my next question. (00:32:51) It’s like, once you’ve, you’ve penetrated the payer or the provider at the local level, (00:32:55) Now, (00:32:57) you almost pierce the veil and economics drive the decision almost, (00:33:02) especially at the payer level, (00:33:03) right? (00:33:03) Because now payers are saying, nope, go use Lena. (00:33:07) This is way more cost effective.
Ryan Eder (00:33:09) once you’re in, (00:33:10) because our model is so transparent too, (00:33:13) and all the data is available via APIs to send back to any of the payer, (00:33:18) the provider, (00:33:19) you name it, (00:33:19) right? (00:33:20) And we just completely transform it.
Brian Bell (00:33:21) Yeah, any of the EHRs or whatever they are.
Ryan Eder (00:33:22) A hundred percent. (00:33:23) So like, (00:33:24) I mean, (00:33:24) you’re, (00:33:24) you’re, (00:33:25) you’ve woven yourself into the fabric of that provider network, (00:33:28) but then you’re also being able to get fantastic economic and clinical outcomes and (00:33:32) patient satisfaction through this AI enabled.
Brian Bell (00:33:35) Let’s talk about looking forward. (00:33:37) I mean, (00:33:37) you’ve accomplished so much since you pivoted, (00:33:39) you know, (00:33:40) six years ago, (00:33:40) what are you excited about over the next, (00:33:42) you know, (00:33:42) five or 10 years?
Ryan Eder (00:33:43) I mean, (00:33:43) the, (00:33:44) the quest is simply to, (00:33:46) you know, (00:33:47) this is going to take more than just laying up, (00:33:48) but the quest is to invert the, (00:33:51) you know, (00:33:52) ratios of PT adoption, right? (00:33:56) If 20 to 30% are accessing PT now they’re prescribed it, (00:34:00) can tech-enabled care invert that, (00:34:03) right? (00:34:04) And deliver more access. (00:34:05) You know, (00:34:06) Lena alone can’t do that as big as the industry is, (00:34:09) but we want to play our part in that. (00:34:11) And so, (00:34:12) you know, (00:34:12) there’s just, (00:34:13) I’ve met so many patients, (00:34:14) whether it’s post-op or chronic that just have been (00:34:18) living with pain for so long or, (00:34:21) you know, (00:34:21) can’t get to their post-op recovery in the way that they need to, (00:34:24) to maximize it, (00:34:25) that this type of model can help. (00:34:27) So our goal is just to be able to drive awareness, (00:34:30) get integrated into more of these provider networks and provide more access to (00:34:34) patients.
Brian Bell (00:34:34) From a payer perspective, what is the cost reduction to them? (00:34:38) Like what’s your, what’s your pitch to them? (00:34:40) If any of them are listening right now?
Ryan Eder (00:34:42) Well, (00:34:42) I mean, (00:34:42) it’s, (00:34:42) it’s meaningful to where we can, (00:34:44) we’re about a quarter of the cost of traditional PT. (00:34:46) Yeah. (00:34:47) So we are getting significant. (00:34:49) twice the completion rates, four times the engagement rates at a quarter of the cost. (00:34:53) with all very detailed outcomes collection that’s reported back. (00:34:57) I mean, there’s initiatives now happening with CMS that are mandating outcomes collection. (00:35:02) If we’re going to pay this, show me this patient is progressing. (00:35:05) Collect data so I can understand that your treatment, was your treatment really effective? (00:35:10) And so you kind of bundle all that up. (00:35:11) It’s very simple for the payer. (00:35:14) It then becomes, (00:35:14) okay, (00:35:15) how do we integrate you into these provider networks and how to make sure that our (00:35:18) referring networks are comfortable with a virtual offering and get our patients (00:35:22) aware of it.
Brian Bell (00:35:22) When did the technology asymptote, (00:35:24) when, (00:35:25) when did you, (00:35:25) it was like good enough to be widely applicable and widely adopted?
Ryan Eder (00:35:29) I mean, (00:35:29) it was, (00:35:30) it probably took that call it 18 months to 24 months of pushing it through remote (00:35:36) therapeutic monitoring with outside clinicians using it to really hammer it down (00:35:40) and make sure.
Brian Bell (00:35:41) Two years roughly from when you started in 2020 to call it 22, you kind of had it working.
Ryan Eder (00:35:48) Yeah, we had it working good enough.
Brian Bell (00:35:52) when you finally crack that code of being able to run across all these different (00:35:56) devices and having a consistent experience, (00:35:58) right? (00:35:59) That’s where, like, it’s always, you know, it’s always nerve wracking. (00:36:01) We have it. (00:36:01) You start sending out patients where you have no idea what they’re using. (00:36:05) You’re like, all right, is this going to just break on them? (00:36:08) Right. (00:36:08) Because people are holding onto their cell phones longer and longer, (00:36:11) but they’re also getting so much more powerful, (00:36:13) right? (00:36:13) They are, (00:36:14) but you’re also like... (00:36:16) Even if you had a circa 2022 Android, (00:36:18) whatever, (00:36:19) it should run fine.
Ryan Eder (00:36:20) That runs completely fine. (00:36:21) We’ve ran on devices 10 years old. (00:36:23) It runs fine.
Brian Bell (00:36:25) But you also not just have the technology, you just have the technical aptitude of the patient.
Ryan Eder (00:36:31) Like when we were building this, (00:36:33) I thought of my parents because every time they have to download an app, (00:36:37) they’re contacting me about their Apple ID credentials. (00:36:40) Right. (00:36:41) I’m like, well, if you can’t get a patient to download your app in the first place, you’re done. (00:36:45) Right. (00:36:45) Right. (00:36:46) Which is why the SMS to browser works.
Brian Bell (00:36:50) Frictionless. (00:36:51) Right.
Ryan Eder (00:36:53) it takes a UX guy, (00:36:54) a design guy like you to kind of think about the friction points. (00:36:58) Yeah, that’s where the design training just really helped out. (00:37:02) Just thinking like, I mean, all right, you’re going to have all these patients accessing PT. (00:37:06) You can’t just make something that like 30 and under can use. (00:37:10) That’s not going to work, right?
Brian Bell (00:37:12) Well, let’s wrap up with some rapid fire questions. (00:37:15) Rapid-ish fire is what I like to say because sometimes they’re long. (00:37:17) What’s an opinion you have about digital health that most smart people strongly disagree with?
Ryan Eder (00:37:23) Most people think that it’s going to replace clinicians. (00:37:26) It won’t. (00:37:26) I don’t think it will. (00:37:27) I think it’s going to supercharge and expand them but not replace.
Brian Bell Right. (00:37:31) Well, I think that’s the Jevons paradox of all technology, right?
Ryan Eder (00:37:34) Yes.
Brian Bell (00:37:34) It comes in, it makes everything, you know, 5 to 10x more efficient and effective. (00:37:39) And then the paradox is you actually get a bigger demand for physical therapists.
Ryan Eder (00:37:44) Correct.
Brian Bell (00:37:45) Than you had before, because now they’re way more efficient. (00:37:48) And so more physical therapy gets done than ever before. (00:37:50) And we see this in other verticals.
Ryan Eder (00:37:53) Yeah, it happens everywhere. (00:37:54) But there’s always like this fear of change from incumbents that then like try to (00:37:59) protect the past and how things were versus adopting the future, (00:38:03) which usually anytime these new ways of technology come out, (00:38:06) like the future is even better.
Brian Bell (00:38:10) But I understand the fear when it first gets announced and not knowing what it’s going to do. (00:38:14) Yeah, let’s all just go back to living on farms. (00:38:16) Sounds great. (00:38:17) Right. (00:38:19) If you could redesign one part of the US healthcare system from scratch, (00:38:24) what would it be and why?
Ryan Eder (00:38:25) It’s the fee-for-service payment model. (00:38:27) It is unbearably conflicted throughout all the stakeholders. (00:38:33) And so there’s just constant tension. (00:38:35) You see it now where everybody’s so upset about premiums going so high because the (00:38:40) cost of healthcare is going so high and the payers are trying to adjust.
Brian Bell (00:38:43) Didn’t Obamacare, I had somebody else on the podcast talking about (00:38:46) Obamacare actually made it worse because it created this cost plus model where the (00:38:49) only way to increase your profits is to actually increase your costs.
Brian Bell (00:38:53) This happened with utilities in California as well. (00:38:55) We regulated and said, hey, you can’t have more than 10.4% profit margin. (00:38:59) Well, great. (00:38:59) We’ll just double the cost of everything.
Ryan Eder (00:39:02) Exactly. (00:39:03) For every cause, there’s effects, right? (00:39:06) And like every push, there’s a pull. (00:39:08) And I don’t think anyone has like, you know, here’s exactly a model that’s going to work. (00:39:13) We just know what we’re doing is not working and it’s getting worse year over year. (00:39:18) And so, (00:39:19) you know, (00:39:19) there’s some nice initiatives out there that CMS is doing to try to test the (00:39:22) waters, (00:39:22) but nothing happens overnight.
Brian Bell (00:39:24) What’s a common AI and healthcare narrative that you think is dangerously wrong?
Ryan Eder (00:39:28) I mean, it goes back to the one before about AI basically becoming clinicians. (00:39:34) They’re just going to be a tool that clinicians use that is going to make them just (00:39:39) exponentially more efficient and scalable. (00:39:41) But I don’t think you’re going to ever get to the point where you’re purely seeing (00:39:45) like your licensed AI doc.
Brian Bell (00:39:48) I mean, maybe in the really long run. (00:39:50) I’m sure when mechanical plows came out for farms, (00:39:53) they were like, (00:39:54) oh, (00:39:54) man, (00:39:54) it’s going to replace all of us. (00:39:55) And it kind of did, right? (00:39:57) 70% of people used to work on farms, and now it’s like 1% or 2%. (00:40:01) So there will be a reduction of force over the very long run.
Ryan Eder (00:40:05) It’s fair. (00:40:06) It’s fair. (00:40:07) And then I think as society gets comfortable, (00:40:13) with as technology evolves becomes more.
Brian Bell (00:40:15) It’s like self-driving cars, right? (00:40:17) You can go to New Francisco and get a car that drives you around like a Waymo, (00:40:21) but that’s just not everywhere yet.
Ryan Eder (00:40:23) No, it’s not here in Ohio.
Brian Bell (00:40:24) Probably 10 to 20 years for it to fully roll out across the U.S.
Ryan Eder (00:40:27) Yeah, it’s not here in Ohio. (00:40:29) To say like, (00:40:29) oh, (00:40:29) like maybe I won’t get a license because I can just catch a self-driving Tesla or (00:40:33) Waymo for cents on the dollar or to owning a car. (00:40:37) Yeah, (00:40:38) there’s this social and economic kind of drift or drag that happens in (00:40:43) technological rollouts. (00:40:44) It just takes a while.
Brian Bell (00:40:45) So what does ethical AI actually mean when lives, outcomes, and liability are involved?
Ryan Eder (00:40:49) I mean, from my perspective, it’s kind of laced in the question. (00:40:52) It’s like it’s ethical AI is that you’re deploying technology, (00:40:56) but not just solely in the quest of profits, (00:41:00) that you are making sure that you are not compromising care quality patient (00:41:05) outcomes. (00:41:06) right and so you know as long as you keep that true north that we’re trying to take (00:41:11) care of people and not just you know squeeze profits everywhere then i i think you (00:41:16) get there
Brian Bell (00:41:16) we talked a little bit about this but what’s the most underrated or (00:41:20) overrated distribution channel in healthcare that founders should be paying (00:41:23) attention to
Ryan Eder (00:41:23) Attention to i don’t think any of them are the hard part with distribution (00:41:29) healthcare is there isn’t really a single channel i think (00:41:32) The employer channel has been really hyped over the last several years because it’s (00:41:37) been less friction to get in. (00:41:39) But kind of what we talked about before, (00:41:40) it’s like less than 1% of where patients actually access care. (00:41:44) So it was something that could go quicker and you didn’t have to deal with all the (00:41:49) complexities we talked about, (00:41:50) but it’s just not where patients are accessing their care. (00:41:53) So I think that was kind of a little bit over indexed a bit.
Brian Bell (00:41:56) What is the hard truth about patient engagement that VCs and founders don’t want to hear?
Ryan Eder (00:42:00) Well, I mean, without engagement, you don’t have anything across the stack. (00:42:03) I think first it’s the getting to the patient in healthcare is not easy. (00:42:08) And so that alone takes the time. (00:42:10) And so as we talk about that alignment of the payer provider, (00:42:13) then ultimately getting to the patient, (00:42:14) right? (00:42:16) Or if you’re going the employer route and you have to spend all these marketing (00:42:18) dollars to make these patients aware of what’s in their (00:42:21) wellness benefits package, right? (00:42:23) That’s not easy. (00:42:23) But then once you get that patient, (00:42:25) clearly, (00:42:25) if they’re not engaged in your care model, (00:42:28) you’re not going to get the revenue, (00:42:29) the outcomes, (00:42:30) none of it, (00:42:31) right? (00:42:31) So like the, it’s just a, it’s a stack up. (00:42:34) That’s just, it’s what your model depends on, but getting there just takes a lot of time. (00:42:39) And I think I saw where like healthcare change is measured in like 17 years is what (00:42:44) like one study showed. (00:42:45) It’s like that kind of deal, right? (00:42:46) Most startups are like living 12 to 18 months at a time. (00:42:51) And you’re trying to say, okay, I’ve got this funding. (00:42:53) I’m going to show how much I can change here. (00:42:56) But like take even just in our world of physical therapy, (00:42:59) like with the like remote therapeutic monitoring model that dropped in 22 and (00:43:02) everybody, (00:43:03) us included, (00:43:03) we’re super excited about it, (00:43:04) right? (00:43:05) Literally the industry right now, (00:43:06) their bold predictions for 26, (00:43:08) four years later is that this will be the year of RTM. (00:43:11) And so like four years gone by to where they think this will be the year they start (00:43:16) adopting that model. (00:43:17) It’s just painfully slow. (00:43:18) Again, the futures here, it’s just not equally distributed, right? (00:43:21) It just takes time to make people change and realize things are better. (00:43:24) On average, (00:43:25) I see roughly 10 years, (00:43:28) 10 to 15 years, (00:43:29) you think about the capabilities of mobile phones. (00:43:33) They’re pretty much here in 2010, but it took until 2020, 2025 for it to be widely distributed. (00:43:41) Everybody has it. (00:43:42) Useful for everyone. (00:43:45) Your grandma’s using it. (00:43:48) And I’d make an argument that COVID actually accelerated that timeline.
Brian Bell (00:43:51) Right. (00:43:52) I had like a, like a regular flip phone until recently. (00:43:55) Right. (00:43:55) Yeah. (00:43:56) Sure. (00:43:57) Non-smartphone. (00:43:58) Right. (00:43:58) Yeah. (00:43:58) I mean, four or five years ago.
Ryan Eder (00:44:00) Yeah, (00:44:02) in a twisted way, (00:44:03) for us, (00:44:05) it was like what made this model doable is that COVID forced everybody to learn how (00:44:10) to do video visits and on to where you had this global event that raised the (00:44:16) technical aptitude of an entire population to some degree, (00:44:19) right?
Brian Bell (00:44:21) I was in Silicon Valley and people were remote back in 2014. (00:44:24) That was very unusual and unique. (00:44:29) In 2024, pretty normal, right?
Brian Bell (00:44:32) Pretty normalized, right?
Ryan Eder (00:44:33) Absolutely.
Brian Bell (00:44:34) If you had to bet on a major shift in care delivery over the next five years, what would it be?
Ryan Eder (00:44:39) just care outside of the, just in general. (00:44:41) It’s just care. (00:44:42) The technology is just going to let people access care when they don’t have to go
Brian Bell (00:44:46) to the- Eventually your phone will be like a tricorder from Star Trek and you know, (00:44:50) you just like self scan yourself and the doctor will be like, (00:44:53) yeah, (00:44:53) okay. (00:44:55) They’ve got these ones like biometric companies that are able to pull a lot of vitals. (00:44:59) Yeah, (00:44:59) your temperature, (00:45:00) your pupils dilated, (00:45:02) the degree of sweat, (00:45:05) skin temperature, (00:45:06) all that stuff. (00:45:07) What does building and healthcare tell you about resilience that you didn’t learn (00:45:10) in design or your earlier life experiences?
Ryan Eder (00:45:13) I mean, based on my journey, it’s everything sticking around. (00:45:16) This is, this is year 20 technically of this journey, right? (00:45:19) Stemming from my thesis and without resilience, that doesn’t happen. (00:45:23) And so it’s not everybody signs up for that. (00:45:27) I didn’t know I was signing up for that and getting into it, of course. (00:45:30) Right. (00:45:31) But, (00:45:31) When you’re in healthcare, (00:45:33) like the rate of change coupled with the rate of change of an administration that (00:45:37) impacts what healthcare looks like to every election cycle as well. (00:45:41) Like there’s just a lot of variables there and being able to navigate those and (00:45:47) stay alive if you go through it is critical.
Brian Bell (00:45:50) What’s a habit or operating principle that you use consistently that keeps you (00:45:54) grounded as a founder?
Ryan Eder (00:45:54) I just try to shut up and listen as much as I can. (00:45:57) I think a lot of people, (00:45:59) a lot of founders, (00:46:00) entrepreneurs like to shout from the rooftops and like, (00:46:03) I know the future. (00:46:05) Here’s what it is. (00:46:06) I like to take a different approach of just understanding where people are and try (00:46:10) to connect the dots and then deliver something to help guide them. (00:46:13) But to do that, just listening, being empathetic and keep building.
Brian Bell (00:46:18) Awesome. (00:46:18) Last question. (00:46:19) What advice would you give to a founder building in healthcare today who feels like (00:46:22) the system is too slow to change?
Ryan Eder (00:46:25) If you’re looking for a quick turn to make a buck and parlay it to your next (00:46:30) adventure, (00:46:31) don’t go to healthcare. (00:46:32) Just don’t do it, right? (00:46:33) Build a chat GPT wrapper for coding or something like that. (00:46:37) Right. (00:46:38) You just don’t do healthcare. (00:46:39) Now, most people in healthcare aren’t looking to do that. (00:46:42) They’re there because the impact they can make, of course, right? (00:46:45) So I think, you know, you go to all these, you know, (00:46:49) the health conference by all different conferences you’re going to hear the same (00:46:52) narrative every year because it takes so long for things to change but you also (00:46:55) hear everyone is there because they just have a passion for impacting people’s (00:46:58) lives and that usually while everybody wants it to go faster that’s that’s the fuel (00:47:03) to their fire
Brian Bell (00:47:03) Love it. Ryan thanks so much for spending an hour with us i (00:47:06) learned a ton about this I’m walking around a lot more knowledgeable about the (00:47:10) space I really appreciate it
Ryan Eder (00:47:10) No thanks for having me. I appreciate it, thank you.
