Take a Deep Breath... Virtual Healthcare is Here!

Brian Urban:                                           
Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we're going niche with a virtual care model that's addressing COPD like you've never thought possible. Joining our show here today is Chief Growth Officer of Conversio Health, Devraj Mukherjee. Dev, thank you so much for joining the show.

Devraj Mukherje:                                    
Quite the introduction, Brian. Great to be here.

Brian Urban:                                           
Well, this is so unique that not only what you're tackling from a disease perspective and doing it virtually, but also with device, it's just amazing what your organization is wanting to tackle and how you're doing it is so unique. So let's get to know you a little bit more here, Dev. Let's go back before the C-Suite title. Who's Dev and how did you get into virtual healthcare? How'd you get into this whole space?

Devraj Mukherje:                                    
Yeah, so I think professionally at least my background isn't so different than a lot of people that end up in digital health. A former consultant, worked at big consulting firms the first couple years of my career. Liked it, didn't really love it, was trying to figure out what would be more meaningful to me. Spent the last 10+ years in a variety of roles across different digital health companies, be it provider, patient engagement, predictive analytics around medication nonadherence. And then now more recently joined Conversio over the last 18 months, as you said, working on the COPD asthma problem. Huge problem in the space. And I think we have a unique way of solving it.

Brian Urban:                                           
It is really-

Devraj Mukherje:                                    
I would say-


Brian Urban:                                           
Oh, keep coming-

Devraj Mukherje:                                    
... Also, sorry.

Brian Urban:                                           
Yeah, keep going.

Devraj Mukherje:                                    
More maybe personally, and I think the audience would probably agree, anyone that works in healthcare, it is personal to us all. I myself have asthma, so understand the nuances of the disease state. Also have had to be a primary caregiver to my late father for many years who experienced quite a few of healthcare challenges. So got to see the variety of obstacles that patients faced and has been on my mind as we take steps forward at Conversio.

Brian Urban:                                           
Thank you for sharing that, Dev, because I think a lot of interesting leaders, impact makers come on our show and they share a common thread that you express, which is something happened in their lives, to themselves or their loved ones that they had to get in front of. And they wanted to carry that through in their career or their life experience somehow that would help others. And yours is right on track with that thread and I did not know that and I love you for sharing that. And I think it speaks to the challenges we have as caregivers and then to ourselves as well. And especially in the world of COPD. Now we have injectables. We still have a lot of nebulizers, inhalers. It's a world that's changing so fast, it's probably very tough to navigate and I love Conversio and your approach in making it very custom and one-to-one. And we're going to talk about your model in a moment here, but let's define Conversio Health. So young organization, your young leader. I can't see any gray hair visible right there. You're hiding it well if so, but-

Devraj Mukherje:                                    
It's a filter.

Brian Urban:                                           
It's a filter. How does this organization come to exist today? Take us through it a little bit.

Devraj Mukherje:                                    
Sure. So maybe not as young as you might think. We're 10+ years old. On the front end of the company's history, we were a pharmacy focused organization, really focused on making and dispensing COPD or asthma nebulizer based medication, which is still core to what we do. But for several years we were focused on delivering medications to the patient at the home.
                                                       
I joined about 18 months ago and our CEO Taylor Cline shared with me the vision that he had with the company, which was to evolve that from not just a pharmacy focused medication fulfillment offering, but a COPD, asthma, disease management company that not only included the medications, but I think you mentioned this before, devices that our patient remote monitoring devices as well as technology and unique high touch service offerings all bundled into one to really think about how to attack different challenges of the COPD or asthma patient that they all faced. So as I mentioned before, today we are a COPD, asthma, disease management company. We work with Medicare Advantage plans. We work with risk-bearing provider groups. We also work with Medicaid as well, all focused on addressing cost, access, and outcomes of course.

Brian Urban:                                           
And that's really helpful, looking at the populations. You're not so specific, you're spread across because a lot of people struggle with this condition throughout their entire lives. Thankfully some can get diagnosed and identified early and others struggle with that in terms of how they're accessing healthcare or have barriers to accessing healthcare to determine if they need some specific medications or support related to respiratory conditions. So with that, Dev, this is an interesting population that you all are treating and in a very interesting way. So off the top, let's look at some healthcare stats. So COPD prevalence is 15% as a marker in Medicare Advantage beneficiaries. So we're talking about those of special needs, but also 65 and older in terms of an age category. And not only that, but it's the third highest spend category specific to Part D programs within Medicare beneficiaries.
                                                       
That's very high. I mean, the only other things higher than that are hearts, and then you're going into multiple comorbidities as well. And then also cancers and heart disease. So then we're also thinking about another economic fact here. Two times higher annual medical costs for people with COPD than the average, we'll say stable or healthy Medicare beneficiary. These are alarming from a healthcare spend and maintenance of condition perspective. So all that noted, how is Conversio really starting to address the health challenges and healthcare costs economically for your stakeholders? Because this is a lot on your plate to tackle. You have a pretty cool model. Take us through it a little bit more here.

Devraj Mukherje:                                    
Sure. So you list some interesting stats. I feel like, and tell me if I'm wrong, a lot of people don't necessarily always think about COPD as a top disease category, be it on a spend or even clinically, the clinical impact of it. And talking about clinical impact for just a second beyond what you just said, 27% of COPD patients generally are only aware of how to prevent an exacerbation, which means 73% don't. About 85% of these patients don't really know how to use their inhaler to begin with. And there's a whole lot of data around how prescribers don't always know how to prescribe the right drug to the right patient based on where they are in their disease. So there's the cost side of the equation and I talked about the clinical aspect of it and as I mentioned before, we've taken a very thoughtful approach on how to really address each of these challenges that both patients and the stakeholders in the healthcare world really face.
                                                       
So I mentioned before, we bundle everything that we really do, the medications, the devices, the service offering, which also includes a virtual pulmonary rehab program and I'll get to that in a second, as well as a pretty high touch pharmacotherapy service model where we have resources, clinical resources on staff who are holding hands with the patient to guide them through their treatment journey. We bundle all these things into one PMPM monthly fee, which turns out, the way we price it, is generally lower than your average monthly spend of COPD drugs itself. So again, this encompasses both drugs, devices as well as all of our services and technology that we offer. So we're immediately reducing pharmacy spend, specifically Part D spend related to COPD. And then we're also driving down medical spend as well, given that there's a lot of data tying med adherence improvement to reduction in inpatient stay and ED reductions as well.
                                                       
So that's how our economic model works. I think you talked about value-based care before. We're able to go to market with the help plans, with the risk-bearing provider groups to align on what those incentives are, which generally is reduction in total cost of care, be it medical or pharmacy spend, and taking upside and downside risk to show how our program can really make that impact. Last thing I'll say about this, again, this transformation for us as a company happened over the last 18 to 24 months. We went out to the market with this fully fleshed out program over 12 months ago, and since then we've been able to drive a lot of significant outcomes, be it on the cost side as well as clinically. And we can talk about that in a little bit as well.

Brian Urban:                                           
I think the approach that your organization is taking to not only managing the condition but engaging the individual is extremely exciting because I think about health plans and I think about providers and the disruption that exists historically between patient having access to medication but also understanding it and then having an outlet for support. I think that engagement piece is probably so valuable to your stakeholders across the ecosystem plans in healthcare that you can't substitute it with anything else. So it seems like you're just a very creative bridge player that's at the right point in growth right now. And I do want to dig into that virtual pulmonary rehab program a little bit more because your model looks straightforward, you improve medication adherence, education, but this engagement piece and this one-to-one clinical support is so unique and I think this is where the economics start to shift. People stay adherent, they understand when and how to prevent exacerbations of their condition, but also where to go to ask questions and support. So walk me through that virtual pulmonary rehab program, Dev.

Devraj Mukherje:                                    
Yeah, sure. So you mentioned before the 15% prevalence rate for COPD within Medicare Advantage. Out of that, generally half of those patients are deemed highest risk or rising risk patients. So on a monthly basis, we're getting data from our clients, be it the payers or risk-bearing providers to really aggregate that data and enable ourselves at Conversio to know how those risk scores for each of those patients are changing over time. Being that we have our own risk stratification models that's informing us of that. As we see these high acute patients either at risk of going into an acute care facility or coming out of one, we are then enrolling them into what is called the virtual pulmonary rehab program. If the audience might be familiar with pulmonary rehab itself, which generally is a 12-week program, you go to some sort of outpatient setting on a weekly basis, have a variety of topics that resources take you through.
                                                       
And we've basically taken that and turned it into a fully virtual model where we have our own resources on staff, be it pharmacists, respiratory therapists, health coaches, patient care coordinators and whatnot. And we've laid out over these 12 weeks a set of topics that are both directly and indirectly related to COPD health. So to give you some examples, this could be physical exercises. A lot of these patients don't have the ability necessarily to actually go down the stairs even because they complain about shortness of breath. There's a lot of general health and wellness challenges that a lot of our patients face. Again, we talked a little bit about education. So patients don't always know how to use their devices. They don't know what are the correct breathing techniques that they could do to really help their general pulmonary health.
                                                       
And lastly, you can imagine a lot of these patients that we deal with might be ex-smokers. So we have a smoking cessation program, part of this virtual pulmonary rehab program that we take these patients through. Again, a weekly session with a different type of resource every week. And then after those 12 weeks, the patient "graduates from the program" and then they go on what we call a maintenance program, which still engage with the patient not just on a weekly basis but on a monthly basis. So that super high touch engagement model, which is incremental value to just the patients who are all on our medication and because of that are getting pharmacy support. But with the virtual pulmonary rehab, they're getting general health and wellness support, exercise education, as well as other content as well.

Brian Urban:                                           
What I think is so interesting about your model is that exercise component of it, because we often don't think about how important our breath is when we're doing different physical activities, whether they're non-intensive or they're intensive and just daily activities. So I think that is so fascinating that you're well-rounded in your approach to being able to provide not just clinical support, but living support for the lives that you serve. So the smart neb. I want to get into this. This is your patented nebulizer. Let's go soup to nuts here from the smart sensors all the way to the use. You've played in devices before, but this seems like it's a very cutting edge piece of equipment that is bundled in the program. So I want to talk about the smart neb. I'm not very well-educated on these types of medical devices, but they play a huge role for someone with a respiratory condition. So walk us through the smart neb a little bit.

Devraj Mukherje:                                    
Sure. So as I mentioned before, I myself am an asthmatic, and so I can remember the years of having to use a traditional nebulizer, which if you're familiar with it, typically is a big box with a lot of tubes coming out of it. Hard for anyone, and thinking back to when I was a kid, it was hard for even my mom to help me manage that. And in the last 10 years of Conversio delivering medication and devices to our patients, for most of those 10 years we were delivering these traditional nebulizers. But as we've transformed now into this tech-enabled digital business, part of our program incorporated this, which it's smaller than an iPhone and this is our portable nebulizer device as you can see it. So there's obviously the huge convenience factor for patients.
                                                       
But even beyond that, it aggregates adherence data back to us so we know if, when, and how the patients are using it. Again, as I talked about the model before, we're again combining the medications, the devices, the virtual pulmonary rehab as well as our pharmacotherapy services all into one. So this is part of that that the patients get. A key component that I didn't mention, and I'll mention it now to our value add to patients is that everything that I mentioned, we generally ensure with our customer that it is at no cost share to the member-

Brian Urban:                                           
Very good.

Devraj Mukherje:                                    
... So going back to the financial barrier piece of this, generally patients don't have to pay any money for any of the items underneath our offering. And given that as well as the convenience of our device, as I mentioned, we're able to generate a whole lot of engagement from a medication perspective given that the goal or rather part of the goal of our program is to convert these patients that have been on a traditionally very expensive commercially available inhalers to our no charge to them nebulizer based drugs. So this device, as I mentioned again, is part of that offering.
                                                       
Now just to talk about our other device that I know we talked about before. So for patients that for whatever reason want to stay on their inhaler, being that we are a pharmacy, we can still fill that commercially available inhaler medication. But what goes on top of the inhaler is this cap, we call it the smart cap. And you probably just heard a voice that came on there. This basically allows the patient to get audio and visual cues. I know probably because of the sunlight, you can't really see the color that will pop up here above the eyes, but essentially as the patient is taking the inhaler, the device is guiding the patient through effective use of that.
                                                       
And going back to the start of our conversation, there's a lot of data around how patients generally don't know how to use their inhaler. Well, I myself was actually one of them when I was interviewing with Conversio. The CEO walked me through this device that was just being incorporated into the model and it struck me how much I didn't know about the right way to use an inhaler, how to hold it, how to hold it in your mouth. Oftentimes patients can blow to the top of their mouth or onto their tongue. So that really doesn't do much from a drug delivery perspective. This device helps negate that. Lastly, the device can transform into what is called a spirometer, which basically that can capture lung function data in real time and that obviously aggregates back to our system on the backend. We're then reporting it to the providers as well.

Brian Urban:                                           
I love that, Dev. And by the way, you're making history in our little podcast. We've yet to have a actual physical demo of something. So that's cool to see. And it was speaking to us in real time. The data capturing from a remote patient monitoring perspective, dare I say, is so extremely helpful. That data being sent back to the provider, making it visible for not only improving medication adherence, but drug delivery, lung functioning, a huge part of the condition that's core to maintaining and improving not just with medication but with clinical care and the one-to-one support from your model and extending out to other healthcare providers that a patient, person might see. So that's very helpful. I think that's very eyeopening. I'm so thankful that you did that because it gives a really good perspective on the actual device, what we're really talking about. So very cool to see that.

Devraj Mukherje:                                    
Exactly. And I'll throw another stat at you, which might actually hit it home even further. A lot of times from our customers, we get the question of how open are patients converting to, in their mind, a very convenient medication, which was their inhaler, takes two seconds to deliver the drug obviously to these longer nebulizer based medication. With this device, we're able to deliver the drug in minutes. Granted, that's far longer than the inhaler device, but given the combination of both that device as well as the high touch service model that we have with our pharmacists and health coaches who are walking the patient through their treatment journey, we're able to generally convert about 80% of our patients from their inhaler to our nebulizer. And again, if they don't convert, we're still filling their inhalers. And that goes to the Part D PBM benefit, but everything else is still covered under Part B obviously. So still the patient's getting a significant savings regardless.
                                                       
So obviously huge engagement numbers that we're able to produce. You talked about engagement before, so I'll throw something else at you as well. We're generally able to spend time with patients 13 times a year. Our pharmacists are talking to them at least once a month, if not a little bit more. So being that we're not just able to talk to them about COPD specific medication management or adherence items, but even care gap support. We do things like vaccine campaigns and obviously now given the rise of COVID over the last couple of years, there's more limelight on the whole pulmonary health space, if you will. So plans and providers are always looking for help to augment already internal care management to what we do. So obviously the tieback is significant.

Brian Urban:                                           
That's a very interesting perspective. We think about the COVID-19 virus, it can have a horrible impact on those that have existing respiratory challenges among other conditions they might be managing as well. And you think about the future of SARS-COVID-4 might not be that far away and the evolution of that virus and how can we have populations best taken care of in advance? And it's through smart devices like this, and it's through education and support.
                                                       
I love that there's no cost impact to the member of the patient's wallet here. I think that's the most important thing that a lot of our audience would resonate with is how are you taking care of the person? Economically that's clearly being met aside from the clinical perspective. So love to hear that. I didn't think we're going to get that deep in it, Dev. And I'm curious too, you have this amazing peak that you're seeing, a very strong value case for your care model for the device, the smart neb, and you're stringing together these amazing partnerships. So as a chief growth officer, obviously you want to grow and you want to make an impact. So let's look out five years. What is Conversio Health? What's the contribution you all have made to population health or the healthcare ecosystem overall?

Devraj Mukherje:                                    
Yeah. Thinking just around Medicare Advantage, so as you know, there's over 30 million beneficiaries within MA. I think it's a little bit more now. We talked about the 15% number. So you do the math, that's maybe a tick under 5 million I'm guessing. So obviously a whole lot of COPD members that we can and should be serving. So that's one thing, growth within the MA side of things. Within that, obviously there's direct to plan and then going through the risk bearing providers who have these pay for performance contracts with the plans. So continuing our growth in those spaces I think is going to be paramount over the short term and the long term. We're seeing a significant uptick on both the program deployment and conversations with managed Medicaid organizations, given that asthma is such a huge disease state within that population, and the even more significant barriers that those populations face from a financial perspective, access, technology, all those things that we can help mitigate and address.
                                                       
So secondly, growth in that Medicaid/asthma space is I think short to a long-term as well. Maybe a little bit more longer term is also taking a hard look at the employer market, which we've already started to think about. But given just patients are unfortunately getting sicker, but either it might be the employee or their family member, could be easily the child, and obviously employers want to provide strong benefits to their employees to address productivity. And tying that back from a productivity perspective, from obviously a cost perspective, I think will be huge for us. And I think just generally from a longer term perspective, identifying how we can control more of the risk, if you will. So is there an opportunity even for us to build out a pulmonary practice, if you will? Go the DaVita model, if you will, or Cricket folks that have done it in the kidney care space, for instance.
                                                       
So that's definitely I think an option, what we'll see. In the shorter term, as I mentioned, the growth opportunity that we have in our customer base, existing customer bases now, one thing to really think about is the impact of the Inflation Act. Sorry, I'm blanking right now. On the Inflation Reduction Act. That's what I wanted to say. The rise of the Inflation Reduction Act, which if you don't know, has a huge impact on the responsibility that Part D plans are going to have from a pharmacy cost perspective. That is going to be four times more in 2025 than it was in 2023. So that impact is actually very short term that I think is going to make a huge difference to how plans and provider groups who are also responsible for this think about outsourcing "the care management," the disease management of COPD asthma, given the financial impact that we can have as we talked about to the payer and the patient.

Brian Urban:                                           
I love that, Dev, and two parts. One, having a physical presence in communities, dialysis centers, infusion centers have had a lot of great success, having more immediate access and support engagement for those managing conditions that are related to having an in-person support need in a center. So that's perfect. And then taking on more skin in the game in terms of financial risk. That is so attractive because then you're saying, "Hey, we're the specialists. We'll take this on. We'll be able to execute on the economics here and also help the lives that you're serving, that we share." That is a beautiful story. We're going to stay connected and in five years, if this comes to fruition, we're going to be able to celebrate it on a podcast or who knows what podcasts will be in five years. But I'm so thankful to have you on our little show here, Dev. Just thankful and very excited to see the growth of Conversio. So Chief Growth Officer Devraj Mukherjee. Thank you so much for joining our show, Dev. This was a great conversation.

Devraj Mukherje:                                    
Awesome. Lot of fun. Thank you so much, Brian.

Brian Urban:                                           
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