The train has left the station to value-based care, and through digital therapeutics, Kaia is well on its way there!
In this episode of Bite the Orange, we are glad to talk with Nigel Ohrenstein, president of Kaia Health, a digital therapeutics company with value-based treatments for musculoskeletal conditions, long-term COVID, and COPD. Nigel considers himself a recovered lawyer and an entrepreneur in healthcare, seeking to have a transformative impact in the industry by making clinically proven digital therapeutics available to people. Nigel explains digital therapy and how Kaia approaches it using motion technology through a patient’s phone camera, enabling high-quality, clinically excellent, physical therapy at home. He shares insights on how to access Kaia and the inner workings and challenges of the company’s path toward its value-based care mission.
Tune in to learn how Kaia is helping people live a better life free from pain!
FULL EPISODE
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Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Hello, dear listeners. Welcome to another episode of the Bite the Orange. As you know, we only speak to interesting entrepreneurs and those that have the courage to challenge the current system, and we are also interested in the idea of democratizing healthcare, which our special guest today, you know, is the president of Kaia health, and one of their principles is to democratize healthcare. So it fits perfectly into what we're trying to do in our future models. Today we are talking to someone that needs no introduction, and I think it would be great person for us to meet today, and I believe he's a solid candidate on to Bite the Orange movement, and I believe he'll be part of this and I hope we all learn from him, and hopefully support him in his movement. So today I'm talking to Nigel Ohrenstein, the president of Kaia Health. So welcome to another episode and your first time joining us today on Bite the Orange. Welcome to the show.
Nigel Ohrenstein:
Thank you, thanks for inviting me. Happy to be here, looking forward to the conversation.
Emmanuel Fombu:
So thank you, so one thing I do when we start the discussions is I always love for you to introduce yourself, right? I don't see the need to go to the bio piece so everyone could get this. But for me from yourself, tell us about yourself like a background piece and what got you interested in this particular space.
Nigel Ohrenstein:
Sure, happy to. So I, as you can probably tell, grew up in London, came to the United States about 23 years ago, spent the initial part of my career as an attorney, as a lawyer. But when I came to the US, I branched out, went to consulting, started ... an entrepreneur, and then really went full speed into healthcare when I went to work for Express Scripts where I helped build the Medicare business. So the beginning of Part D and then move from there really, on the vision of John Doe to help start a company called Lumeris. I was part of the co-founding team of a company called Lumeris, which we built to a multibillion-dollar company helping people move from fee-for-service to value-based care. And so we really pioneered a lot of clinical models around the transition from fee-for-service to value-based care. We also ran one of the country's best Medicare Advantage plans, which was obviously a fabulous ride. As you know, healthcare moves so slowly, but we tried, my passion has been how do we do things that are transformative, not just incremental. And that was really what interested me about joining our co-founders at Kaia, Konstantin and Manuel, to help to turbocharge what we're doing here at Kaia, which I also think is transformational. And that is really how to take, you know, clinically proven, which I think is really critical, Manny, we should talk about what that means as we chat today, but clinically proven digital therapeutics and make them available to people. And so what I think is transformational is we know that access to care is one of the major problems that the US healthcare faces, and so the ability to enable people to access high-quality clinical care anywhere, any time really can make a massive difference to so many people. And that's really what we're all about at Kaia and really what my passion has been for the best part of the last 20 years.
Emmanuel Fombu:
Yes, and in particular, thanks for that intro piece, and I think there's a beautiful story behind Kaia Health, right? Which is separate from your own particular story, but I like to call that out in particular, if you look at Kaia Health, the two co-founders, I believe it's Konstantin, right? And Manuel, which finally my name is Emmanuel, so Manuel kind of, a relation to that piece, but they had a personal story connected to this, correct?
Nigel Ohrenstein:
Yes, for sure. So Konstantin had chronic back pain and he had, was fortunate enough to go to a residential treatment where he went in every day there was a multimodal therapy that dealt with both the mental side as well as the physical side. He had the ability to go into a treatment room that had multiple cameras, multiple clinicians looking, looking at you. And he left that and thought, you know, like all great entrepreneurs, how do we make this available to the masses, right? How do we ensure that something like this is not just available to the few, but make it available to the many? And so he sent, went out to work to build what is now Kaia, to build motion technology through the camera of your phone or iPad that enables you to receive high quality, clinically excellent physical therapy from your own home. And so what's really fabulous about this technology is that the, basically what we've created is imagine, Manny you went into a clinic and there were 20 plus cameras on you and multiple clinicians looking at every angle to the way you move in sort of 4, 3D, and we've managed to develop that and enable people to receive that through the camera of their phone. That is just wild, and when you think about what technology can do for the good to enable people, that is just unreal, and that's something I find like almost incredible but so exciting. And that's really sort of the DNA of our company is was started then with like how do we help people live a better life free from pain.
Emmanuel Fombu:
That is something that's very interesting. And I like companies that come from patients, especially, because they actually went through this experience and they got something that benefited them, and they're building a solution that will benefit other patients like them, right? And that's very critical. But in this particular case, I wanted to explore more on this topic of digital therapeutics and what it is, because a lot of times I hear people ask questions such as, Do you think that the time for Digital Therapeutics has passed? Do you think, it's like asking a question, do you think that the type of Netflix has passed or the time for Amazon has passed or the time of Google has passed, right? I think personally it's a silly question, right? Because if you understand the concept behind it, right, I think you understand that it's here to stay. So with that being said, an overall perspective, what is digital therapeutics to you?
Nigel Ohrenstein:
Yeah, sure, so to me, a therapy, let's start before we get to digital, right? A therapy is a course of treatment that helps you get better, right? And that could be something mental, right? It could be that you do some type of mindfulness or it could be something physical, right? Or it could be a drug, right? You go to the doctor and you get prescribed something, and that's part of course, of treatment. That is, all comes together to be called a therapy. What a digital therapeutic is, is the ability to deliver that as part of a therapy through a digital channel, which not only enables obviously the ability to enable people to access it, you know, at scale, right? You can, it's delivered digitally, but in addition, it often doesn't come with some of the side effects, right, that you have when you have to take some type of medication. And so I think there are two important things to think about in addition as we think about digital therapeutics. One is just like we just spoke about a therapy, a therapy can contain multiple different things. So digital therapeutic doesn't have to be a replacement for in-person care or replacement for drugs, it can often be a complement to that. And so as you think about a therapy, right, it's, it doesn't mean like, oh, I have to do a and not b, how do we think about it as a compliment? And the second thing, which I think is really, really critical, Manny, is that these digital therapeutics should be held to the same standard that we hold drugs to, and so what I mean by that is that we should have clinical trials, randomized clinical trials, peer-reviewed, and so that's really important to us here at Kaia. We've actually taken our therapies through 11 randomized clinical trials, peer-reviewed, establishing sort of the same clinical excellence that you would expect from a drug that you would put into your body.
Emmanuel Fombu:
I think that's the best definition of digital therapeutic I've ever heard, ever, and I think it makes a lot of sense, right, because a lot of times people fall into the world of AI, for example, is I think in robotics, the magic thing happening behind it, right? And this is not validated. This is clearly validated. And I like the fact that your background is from being a lawyer. For example, ... perspective, especially on the regulatory and the compliance aspect of this, and I think one of the biggest challenges and one of the reasons behind Bite the Orange is people have this fear of adoption, right? Because they believe that, oh, it's an app or some technology piece that maybe it's not validated and they don't know. So they're scared to take that first initial bite, right, to see what the outcomes are. And you have lots of papers like you mentioned, that have great outcomes around it, which makes it very interesting. And just to add to a certain piece, you have specific therapeutic areas that you're focused on, right? So, you know, for example, having telehealth dealing with diabetes. So if someone, for example, is a, how do you compare it to another digital PD company, it is completely different because what you do. So what key therapeutic areas are you focused on currently and what do you see yourself going in the future?
Nigel Ohrenstein:
Yeah, sure, so we started life, as we discussed, focused on musculoskeletal issues. So any type of pain that, back knee here, etc., etc., right? So that's where we started life and that's obviously a big part of who we are in our company. We also focus on sort of two additional areas. We have a solution for COPD and we also have a solution for Long-covid with therapy, and Long-covid solutions are very similar. They focus on pulmonary rehab, which all the literature will say is a really critical part of managing COPD, and we believe it's a critical part of managing long COVID as well. And it's really hard to access pulmonary rehab even in person today, even in New York City, Manny, where you and I both are. It's not easy to access pulmonary rehab, yet all the literature says that's a really good thing for managing COPD and long COVID. And so the ability again for us to make something like that available digitally is just unbelievable, in helping people access care that enables them to manage conditions that we know can make life really difficult. And so when you think about something like COPD, the, you might not even be able to get upstairs, right? Or you might not be able to vacuum your house and engaging in something like pulmonary rehab can enable you to do the tasks that perhaps you weren't able to do before. And so the, both what ties up our strategy together, right? Are really two things, right? One is how do we enable people to access care, to live a better life, whether that be pain-free or managing that COPD, and then secondly, how do we utilize sort of this, which is, as I've said before, unbelievable motion analysis technology that enables us to really have a real-time analysis of how somebody is responding to treatment?
Emmanuel Fombu:
Which is extremely interesting and very important. So a lot of times I think most of the listeners, especially if you have not worked in a digital health digital company, right, you think, okay, so now I see Kaia health, how does your business work? So do I go on to App Store and download it? I mean, somehow someone needs to cover it because you need all this evidence to prove that this works. So you're not a direct consumer kind of product, correct, right? So how does it currently work? What's your target audience?
Nigel Ohrenstein:
So today people access it either by their employer covering it as a benefit or the health plan making it available to their members, and so that's, that's how it works today. So if you do want access to it and you don't have it, then send a note to your head of HR or to how-to benefits or to your health plan and say, Hey, I would love to have access to Kaia. In the future. I could see us complementing the sort of the B2B approach with a B2C approach, and so that's something we're, we continue to think about, but right now we actually you can access it just through your employer or your health insurance company.
Emmanuel Fombu:
Gotcha, so so please, if you listen to what Nigel is saying and you believe in Bite the Orange and the movement, that's the point, right? You want to reach out, because I've seen, working in corporations in the past where I've gotten I've gotten emails that say, hey, we have another app for like for calming down things like, for example, right, or Headspace or, or someone I think with diabetes or something different. So here I mean, thousands of people that have, millions of people that have chronic pain, back pain, for example, right, or COPD. So what you're saying is if you have this kind of conditions, you might not have this app of something available to you, but you have a unique condition, if you reach out to HR team or you reach out to employer or your insurance company, they should be able to reach out to Nigel, right? I'm sure we have your contact information, be on this post and also listen to your Marche Health, of course, right? The world's largest digital health marketplace and communities, the people that actually come up and then find out more about your solution, right? And be able to identify the solutions. So what has been the biggest challenge you've faced so far? Because what, it was a bottleneck.
Nigel Ohrenstein:
You know, it's healthcare moves so slowly, Manny. That's the thing that I find so frustrating. I feel like we're on a mission, and, you know, you and I see the problem and see solutions. And we're probably like-minded and we get frustrated that people don't want to move as quickly, and so that's really the biggest bottleneck. There is almost nothing.
Emmanuel Fombu:
But on that point, I used to think that lawyers were the bottleneck, but that, it's interesting to talk to a lawyer that has an utter opposite view of it. So that's great, I'm sure it's, the industry issue is not.
Nigel Ohrenstein:
I like to think of myself as a reformed lawyer. So many, many years out that I'm, that I've gone through my retraining and rewiring of my brain. So yeah, yeah, so we, so it just so that's, that's the biggest challenge, right? You know, deploying, it's almost like I use this analogy a lot with my team, right? Which is, you know, when you go to the supermarket today, like I don't know if anyone still goes to the supermarket, but when we used to go to the supermarket, right, they used to be, you could, you had self-checkout and you had, and you could still go to a cashier and check out through a cashier. And for some people, they always want to see a cashier. Like my grandmother would have hated the idea that she couldn't chat to Betsy on the way out of the side of the supermarket and find out how her day is. And for some people, the digital checkout is better, right? They prefer it, and for some people, they might prefer digital on a day when they have five items, but a self, go to a cashier when they have 300. And so to my mind, that's the challenge that we put out to health insurance companies, to employers like you almost have nothing to lose by marrying a digital solution with what you currently offer your employers, your employees, or your, or members of your health plan, because it's complimentary. And again, if you look at our clinical trials, it shows that we do no harm, that it's safe, that, and so we're only benefiting society. And so what frustrates me is, is how the pace at which the healthcare market evolves and the challenges and the sort of roadblocks that different organizations put in front, hoops to jump through, you know, that just slows everything down, and I wish everyone would see the opportunity and move faster.
Emmanuel Fombu:
I love that example you gave about a grocery store piece. Several years ago, I used to live in Washington, D.C., and I had friends, I lived in New York at the time, and then I moved back to D.C. and they told me that they used to order groceries and they got delivered. This is before even apps for delivery things happened. And I thought it was the most ridiculous thing that ever happened. How lazy are they? Like, just go to a grocery store. I was that person. Now I can remember the last time I went to a grocery store, right? I bet my groceries online now and they get it delivered. And this goes back to that idea of crossing the chasm, right? There's a book about this whole concept about it, right? There's early adopters. ... is a great book, fantastic book, and how people follow it, and now this whole movement piece. Except I feel in healthcare, that we are stuck in this place where there's no central platform and central interest. People could explain to people in basic comments and guidelines that when it comes to the world of technology and healthcare, you don't have to be a clinical doctor. All of us are involved in this particular business of it, right? I mean, I'm a clinician by background, but I spent a lot more time with engineers. We need everyone, it's team effort to make this happen, right? But we have to communicate this in simple terms. I understand the benefit of this, right? So there is a benefit of why a payer will actually pay you right and do things with you. Your employer will pay you to provide services to members because this is an outcome-based medicine. So to me, I love it because this is a perfect example of value-based healthcare, right, of where we are going. So with that being said, do you see yourself going into other therapeutic areas going forward beyond what it is? That's one, and two, do you see yourself growing outside the country? Because I believe you have an office right now in Munich, right? You have an office.
Nigel Ohrenstein:
We do, so I think over time we will expand to other therapeutic areas. I think for now we're highly focused on MSK, COPD, long COVID. I don't see us expanding in the short term beyond that. But, you know, over the next couple of years, I think it wouldn't be a surprise if we did expand into other therapeutic areas. The opportunity, though, in front of us for the disease, as we just said, is massive, right? And the opportunity to help millions, if not billions of people around the world is really, really critical. And so today, as you mentioned, we have a business in the EU and we have our business here in America, and so we're highly focused on both of those. And we get called all the time, you know, come to Indonesia, come to Japan, come to China, come, right? And you know, the challenge of an entrepreneur, right, is that we all as entrepreneurs, we always are excited about opportunity. And so part of our challenge is, and the challenge of all great entrepreneurs, right, is to stay focused, right, and not spread yourself too thin. And so I don't see us expanding to other additional markets in the short term and really focus in on the markets that we're that we've got right now, the EU and the US, which are obviously two huge markets in of themselves. But over time, again, I would see us expanding beyond those markets as well. But that's always the challenge, right? How do you stay focused? But also you just want to run after every opportunity that exists.
Emmanuel Fombu:
Yeah, you can't be a jack of all trades in a particular business, right? The concept stays the same, but there are specific verticals. You have expertise in chronic pain. I don't have that expertise in chronic pain, right? So you have to go deeper in that to make sure everything is validated to bring this to the market. This happens, this is same thing with pharmaceutical companies, right? They don't make drugs for every single disease. They just focus on rare disease, those on oncology, and then there are different things, so it depends on where you go. So with that being said, I want to get back to your background, Nigel, which is something that interested me for us to have a conversation beyond your company piece, that's secondary to our conversation. So you've been a ... entrepreneur in the space and you ... Express Scripts like different kind of players in this particular space, right? What has been something that you've observed over the last, you know, the last ten years where the industry is going, challenges that we've in the past that we have accomplished, and what you've learned about the industry in general, that an average listener coming into this space, being a new person, can learn from that?
Nigel Ohrenstein:
Sure, that's a great question. So, you know, to my mind, having spent a lot of time focused on value-based care and the move to, the move away from fee-for-service, the data that I've looked at and studied extensively in the different methodologies and clinical pathways, you know, seem clearly to point to the fact that when you align incentives, you can drive better outcomes, right? And by better outcomes, I'm talking about both better, better clinical outcomes as well as more cost-effective care. And it's the challenge of our generation and probably the generation after us as well, right? We've said for so long that healthcare costs in this country are out of control, that it's too large a percent of GDP, and we're getting towards that point where it's going to be a noose around the neck of American business. And that's where it's not just a challenge for people that live and breathe healthcare, but you might have a real estate business or you might have a supermarket business that we're talking about before. And healthcare costs are continuing to be a bigger and bigger slice of what it costs you to do business. And so, I'm a massive believer and we have to move the industry to value-based care. I know that some people are burnt by what happened in the past with capitation, and I think we live in a different era, right? And, you know, another story I always tell, right, which I love is, I was once, I was visiting my parents in London and we had to go to a wedding. And, you know, I was sitting on the couch watching a game of football, soccer.
Emmanuel Fombu:
And what team? What team?
Nigel Ohrenstein:
My team is Liverpool. I'm a, my family were all big Liverpool fans. So we're watching, and then my mom and dad said, you know, we can't be late. It's a family wedding. We are going to be there for photos. And they leave close to 45 minutes before us, and we're like, we're not leaving till the end of the game. Anyway, we're walking into the venue, and as we're walking in, my mom and dad pull around the corner, and I look at my mom and dad said, like, what? You took the scenic route, right? And the moral of the story, right, is that my dad's been driving in London for his whole life. He knows the back roads, he knows he knows London like the back of his hand, right? But as a result of that, he refuses to use Waze, right? And so I don't know London, I know London well, I grew up there, but I don't know it anywhere near as well as he does, but I turn on Waze, even if I know exactly the way I'm going, because it provides me with real-time information, real-time data, right? And so that's the difference to me of capitation in the old days versus where we are today, the ability to have information, data, use of digital solutions like Kaia, the ability to engage people in different venues, it's a whole different ballgame. And so I guess long-winded answer, Manny, to your question is, what have I learned over the last decade? I think the train has left the station to value-based care. Everybody needs to figure out in the healthcare ecosystem how they plan it, and to your mission of getting people on board to bite through, as you told me the sour part of the pill to get to the juicy part of the orange right, we need to continue to put pressure on the institutions in any one market that are holding it back. And in any one market that could be the clinicians, it could be the hospital system, could be the payer, could be the employer. It varies by market, and we need to push through that because that is, it's the challenge of our generation.
Emmanuel Fombu:
Exactly, we need to bite through the orange, and that's the concept. And I think there's a perfect way, Nigel, I think, to wrap up this conversation about the concept of, it's about us accepting it's not the technology that's there, it's not the science that's not there. The people that are standing behind, right, the innovation that could take place. And so when we talk about the future of healthcare, a lot of times people ask me, are you talking about future in 40 years from now, 30 years from now? And I go, No, the future is here now, but let's start there, right? We can move it slowly and go to where we need to go, but this movement is not about me. It's not about you, Nigel, it's about people believing that things are there to be done. And there are teams that are, there's an army of people behind this. So the idea there is a movement that we are creating, the movement is people are going to understand what the technologies are out there. And if you call the HR and your company or your payer and you tell them you have chronic pain and you need Kaia and they have challenges about it, you should Bite the Orange and share that #Bite the Orange, right? Let's create a movement to change what people think, right, and enable the future of healthcare to make that a reality. So thank you, Nigel, for joining us today, and I look forward to having you again in the near future.
Nigel Ohrenstein:
Thank you, Manny. I enjoyed the conversation, it was great.
Emmanuel Fombu:
All right, thank you.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com, or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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About Nigel Ohrenstein:
Nigel Ohrenstein is the current president of Kaia Health. He is passionate about transformational solutions that improve the cost and quality of care. Most recently, he was the co-founder of Lumeris, helping to build Lumeris into the leading Value-Based Care Company and operator of Essence Healthcare, the Five Star rated Medicare Advantage plan. Prior to Lumeris, Nigel led the Medicare business at Express Scripts. He has a BA and MA from the University of Cambridge.
Nationally recognized as a thought leader in healthcare, Nigel is excited to democratize healthcare and through Kaia Health, make clinically proven digital therapies available to patients anywhere and at any time.
When not working, Nigel can be found running, traveling, spending time with family, and watching Liverpool FC.
Things You’ll Learn:
Access to care is one of the major problems that US Healthcare faces.
Digital therapy can deliver treatment through a digital channel, enabling access and scale, and can be complementary to in-person therapy and medications.
Digital therapeutics should be held to the same standard as drugs, with peer-reviewed randomized clinical trials.
Motion analysis technology enables Kaia to have real-time benchmarks of how somebody responds to their treatment.
People can access Kaia either by their employer covering it as a benefit or by their health plan.