Everyone’s Health Needs a Great Sidekick…Sidekick Health is Here!

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host Brian Urban. Today, from a four-hour time difference, we're so thankful to have on our show here, the CEO of Sidekick Health, Dr. Tryggvi Thorgeirsson is joining our show. Tryggvi, thank you for being on our show.

Tryggvi Thorgei:

My pleasure, Brian. Great to be here.

Brian Urban:

Tryggvi, it's amazing obviously you have a presence in Reykjavík, but you're also in Berlin in Switzerland, and then good old Boston and the United States as well. What a global route that you have to Sidekick Health. Before we get into the organization and the impact you're making, let's start with yourself.

I had love to get to know a little bit more about who Tryggvi is before the MD, before your NPH work at Harvard and even before becoming one of the co-founders executives here of Sidekick Health. Who is Tryggvi? Take us through the journey.

Tryggvi Thorgei:

Well, who is Tryggvi? Like I said, I live here in beautiful Iceland. I really enjoy here and it's interesting how Iceland is. Well, we're basically a volcanic rock in the North Atlantic, but we're quite in between North America and Europe in both culturally and geographically and it's actually not a bad place to do business.

You're forced to be born global I think when you're here because it's such a tiny market. I've lived abroad in many places. I lived for three years in Canada as a boy and spent a lot of time in the US as well. Then actually, before starting medicine, I went into engineering. I've always been really fascinated about the intersection between technology and medicine and how we can leverage technology to be more impactful in medicine.

I live here with my wife and three children. My son is nine and I have two daughters, 12 and 14, and that's the background. I went into medicine and started after med school, we do here at Iceland, what's called a rotational internship where you really practice medicine across various different parts of the field.

We're such a big country but with a small population, we also do a lot of what's called the real world medicine where you're basically the only doctor in a big area and you're all on your own and you have to do more or less everything. That's really, it gives you a very accelerated view of healthcare, I think across all the different needs.

Brian Urban:

It does. Thank you for sharing the background, a very humble of yourself. You missed out on a few of the amazing things that you do aside from advising the Prime Minister of Iceland on innovation and all of your work in the US. Your training is so suited now to the challenges that are becoming more apparent in the US in terms of population health, addressing social determinants of health.

When you think about rural and healthcare access and health literacy, it's an intersection that needs to be addressed now more than ever. So your background and kind of the biosocial psych view and in rural medicine as many European Scandinavian physicians are trained in is so applicable to the US.

I feel like you're just so far ahead in terms of the medical education you've received. The more well-rounded way is just probably really helped the deployment and success of Sidekick Health. I do want to get into Sidekick. I love what you're doing, so poised for growth right now. Let's talk about sidekick. It's young, it's growing. Who is Sidekick Health today, Tryggvi?

Tryggvi Thorgei:

Thank you. I guess, it stretches back to my days as a clinician. I think very early on when I was practicing medicine, we have a really great healthcare system here like in the US. Very early on I felt we were approaching healthcare from a very strange angle. It's so incredibly reactive, so we wait for disaster to strike before we really pour resources in.

We also as doctors, really don't have any tools to empower our patients to be actively involved in their care and that's something that I think is becoming an expectation from patients and members and people to be able to have a much more active role in their care. It's also incredibly brick-and-mortar based, so we have to have folks come into these really expensive brick-and-mortar clinics and hospitals instead of doing so much more digitally through technology.

It reminds me of how banking was 20, 30 years ago where you'd have to go to your back to withdraw funds or do whatever. Now, we do almost all of our banking services and we process them through digital.

Brian Urban:

It's quite an evolution.

Tryggvi Thorgei:

It is, and that's what pushed me to see if we could do things better. I went to Boston to Harvard to study public health, really passionate about that, how we can work provocatively. I studied also behavioral science, how we can use behavioral science to better engage with people in healthcare. Did research on that with my mentor at the school Professor Ichiro Kawachi.

We published a paper in the American Journal of Preventive Medicine on that topic. I'm actually now a guest lecturer at Harvard on that topic using Sidekick as a case study. That's a nice circle I guess there. With all of that background, I then founded Sidekick now 10 years ago with my friend from med school, so founded by two doctors.

I think that also has heavily influenced how we have built the company. We knew from day one that most of the people that we help in healthcare are dealing not with one but multiple conditions at the same time. That's why we wanted to create a whole platform and be able to apply that platform across a wide range of basically all the major chronic conditions.

All the past 10 years we've been with a great team working on building out over 20 conditions or progress that cover over 20 conditions across oncology, heart diseases, metabolic diseases, inflammatory diseases, women's health, and just a whole range of major conditions, and even building technology that allows us to tie together.

If you're dealing with two or three different things, we tie that together into one patient journey. You just have that one home. You don't have to have all these different point solutions to help you with these different diseases.

Brian Urban:

I love where you're going, getting away from point solutions and having more of a matrix. I think definitely need more than ever. I think what we're going to get into the adaptive care path really seems like your flagship right now addresses behavioral and mental health as well as something that's an underlying component to all the different conditions someone might be managing on their own and with a healthcare provider as well.

Tryggvi, just so fascinating how the sidekick has grown out of your experiences and you're also giving back in the academia world. I think that's another interesting connection that we have and that's why I was so excited to be able to talk to you today. We both have a public health background from the northeast in the United States. I got my 66North gear on for our audience here in the video.

I had to represent for Reykjavík, Iceland overall. There's a term, but we will get back into Sidekick. There's a beautiful term that I think speaks to your brand and your approach, maybe business philosophy as well from where you grew up in Iceland. It literally translates into, I believe everything will work itself out, something like that.

Can you please just give us the Icelandic phrase and break it down for us? I think this would be a very educational for our audience.

Tryggvi Thorgei:

Yeah. Well, it's a term in Icelandic we say [foreign language 00:08:16] and it's a very Icelandic term and there really isn't a good translation for it that I found. It means it just like you said, it is all going to work out, it doesn't mean that it happens by itself. We work hard to make it work out, but it'll work out in the end. That's something I think it's helpful to keep in mind when you're working and living the hard life of an entrepreneur. It will work out in the end.

Brian Urban:

[inaudible 00:08:41] of healthcare in the US today, there are so many health tech vendors. We were just talking about Vibe before we started the recording and HIMSS where I just came from. It's an overwhelming amount of tech vendors today, trying to put themselves in the space. You've been around for now, just going over a decade so young but not that young.

You've clearly made an impact clearly past the traction gap in terms of your maturity. I look across the space, I see these amazing trends. Medicare Advantage, as you know, the population of the US, it's been growing about an 8% clip in terms of enrollment year over year since about 2010. Then Medicaid churn is inevitable. Engagement is so fragmented.

Health plans don't even have the right contact information to actually reach out. Trust just isn't there right now. Then I look at commercial populations and I think the biggest theme is mental health and balancing your medication with behavioral mental health as an underlying foundation to that as well. Then, I look at you all, and I mentioned earlier the adaptive care path.

I wanted to get into that a little bit more. It seems like that's the main digital therapeutic play that you all have had in recent years and a lot of your case studies and research from a clinical outcome perspective and right-sizing healthcare perspective has come from. Can you tell us a little bit more about the impact, the adaptive care path has had in recent years?

Tryggvi Thorgei:

That brings us back to this core design principle that we had is keeping in mind that we're helping people with this whole vast range of conditions that they're dealing with, and they're all interconnected. You might be dealing with anxiety or depression and obesity and diabetes and maybe even something like breast cancer or Crohn's disease.

It's always going to be a complex mixture of things and they're all interrelated because if your mental health is in a bad state, I'm not going to be able to help you address your other parts of your condition without being able to address that. That's what we've done by having these over 20 conditions that we cover. We can tie them all together through adaptive care paths.

When you talk about mental health, we typically see in our programs from 25% to 40% improvements in mental health measures, be it anxiety or disease specific to stress, that then in turn has a positive impact on your other elements. It's all interrelated. You mentioned the Medicare Advantage growth. We're all aging and that's a good thing.

Also as societies, we're getting bigger and older and that just keeps adding strains to our healthcare system. Again, as a clinician, you see that every day and we're not going to solve that by just pouring more money into it or asking people to run faster when they're working in the hospital. We have to be able to leverage technology to augment the fantastic work that our people are doing in healthcare.

That's why this is really, I feel this is just my passion to help fix that. Technology just has these amazing ways of scaling what we're doing and working much more upstream and picking up on things way earlier than otherwise.

Brian Urban:

Yes. Upstream I think is one of the biggest value pieces that your technology brings to the table for health plan specifically. The early engagement, it seems like this is another big impact that your technology has on the lives that it serves. It's not just about the actual workflow within it and a lot of the education within your technology, it's also the engagement.

Are you finding a lot of, I'd say improved engagement metrics that are very tangible that's helping improve trust for a health plan and the members that they're serving?

Tryggvi Thorgei:

Absolutely, and we're fortunate to be working with great partners including health plans like Elements Health, which is the biggest health plan by member volume, and then just lots of great partners that we work with on a daily basis. This is exactly like you said, this is such a core issue is creating that trust and connection between the member and the plan or their care team.

Opening up access that's otherwise difficult because for example, telephonic care management, it's not really scalable and it's hard to do outside of office hours, but this way you're always one click away from your care team and that really builds that trust and just access to all that care. If you think about a care manager in the setting, you have this basically cockpit or this dashboard and we pre-populate it with all the data that we have on your member.

That can be diagnoses and claims data and medication information. Are they filling their scripts and just whatever is relevant? Then, we populate with through remote patient monitoring, we can see what are the symptoms that this patient is dealing with that we can flag if things are going off track? Then, we have all the behavioral data because also working with a member on be it their diet or physical activity or sleep or stress or whatever.

We have all that data and then we use AI to really summarize and condense what's the signal in all of this noise in that sense and flagging what's the next best action? We can even then use AI to pull together from all that data and from all your previous chat history, what could be a relevant next message to this member. The care manager can either just within two seconds click and send or they can take a bit more time and edit and send it.

You do all of this within seconds instead of spending so many more minutes on the phone. We're able to pull this data so early that you can in many cases, step in even days earlier than otherwise. There are just amazing stories that really is what motivates us to keep going on how we've saved lives through exactly this approach.

One story that really is close to my mind is a gentleman in the US about my age who's dealing with a very serious cancer, unfortunately. On chemotherapy, which suppresses his immune system, making him really vulnerable for infections. He was using and is using our system with his health plan. 

One day, he entered the symptom. He didn't really think much about it, but his care manager, our assistant flagged it and the care manager felt it looked off and had a closer look and texted with a member and then called him and ended up calling his physician. Within a couple of hours he was admitted to the hospital.

Turned out he had a bacterial infection in the bloodstream, which most likely would've been fatal within a few hours. He really hadn't realized how serious these symptoms were. Pulling all that data together, you can flag it early and you can step in early. Either saving lives or saving much more expensive downstream ICU hospitalizations and such. Then, this is really the power of digital and healthcare, how that can really help.

Brian Urban:

It truly is, and that's a beautiful story and lovely of you to share. I think when we're looking at these solutions that are going to market, the end goal is to be helping another human and we can forget about that. You obviously do and it shines through with a lot of the thoughtful things that Sidekick has taken to market in the partnerships that you are striking as well.

I do want to touch on remote patient monitoring and then get into a little bit of the partnership side of Sidekick Health. You mentioned a lot of that remote patient monitoring being pulled in from a data analytic standpoint, and then how you maybe synthesize some of those pieces of information through AI and maybe some machine learning overlay there.

I think what's so interesting is the Best Buy Health and Ochsner, their O Bar in the United States and what they've been deploying in rural communities and some urban communities, but mainly around those that are of a lower socioeconomic class in the US and of more of a challenging climb to improving health literacy. I think for me it's fantastic.

I think it's probably tough to get a lot of those cultures to adopt it without having the balance of a person in front of them helping them. Have you seen remote patient monitoring be a huge uptick in terms of adoption that you're pulling data from to eventually help the end member patient? Is it still climbing? Remote patient monitoring still has a long way to go and a lot to figure out. What's your take on that, Tryggvi?

Tryggvi Thorgei:

Well, that's a great question. Again as a clinician, I'm fascinated by the capabilities just to allow us to identify things early, absolutely helping us be proactive. I think it can struggle if it's quote unquote "just empty remote patient monitoring." I think at least what I enjoy is tying it into a wider patient experience.

Like at least what we do in our programs is you have your app every day, we serve you a small piece of content or education or a mindfulness exercise, whatever's relevant for you to be working on. At the same time, if it's relevant, we prompt you and ask you to either tell us about a particular symptom we're looking at or we import from a device that you're using so it happens automatically.

If it's part of a whole health journey, I think it's incredibly powerful and it definitely can also help with the engagement part as you mentioned. I think people really value in many cases this kind of knowledge that someone is really looking after you and can track if things are going off. I love the concept. We definitely have to keep scaling it across healthcare.

Just like you said, I'm a big believer in this what's often called the omnichannel approach. It's never going to be fully digital. It definitely cannot be fully non-digital. This combination of having a person there, a healthcare professional, but augmenting them in every positive way through technology and using devices to just get more data, that combination is really what unlocks a lot of power to me.

Brian Urban:

Well said, and I was hoping you were going to be leaning that direction. It seems like as we continue and you go to many conferences in the US globally as well, you have a big impact in play Germany that I was going to ask you about too. It seems like we'll find out in another year or two if some of the players we see now are still there and it'll prove out their technology and their impact as well.

So promising the future of how all different types of technologies are being used upstream to have a good impact downstream for the individual life they're serving. Partnerships are a big thing for Sidekick Health, not only through the story of your growth, but obviously how you're helping a lot of people as well, particularly in the US.

Aidhere was a recent acquisition. You had announced this, it's on your website. It's an amazing story. Can you tell us what Aidhere, the acquisition really the partnership now within has meant to Sidekick Health?

Tryggvi Thorgei:

Absolutely. Taking us back to where we founded the company, my very first investor presentation 10 years ago, I found it the other day, and it says Sidekick Health, the new prescription for chronic conditions or something like that. I think that's the condition. I always wanted to create a digital therapy that a doctor like myself could prescribe, but it would be fully regulated just like a medication.

You'd have to have followed research to show that it works and it would then be reimbursed by health insurance companies. That's what's been termed Prescription Digital Therapeutics or PDT. I've basically been waiting for the past 10 years for that particular segment of our market to mature because it definitely hasn't been mature.

As an entrepreneur, you can't spend money and resources and time on a market that just isn't there and you don't have that reimbursement or distribution infrastructure. I've been patiently waiting, I've been tracking the US market. Unfortunately, there's been ups and downs and some pretty turbulent times there.

I think that's going to have a negative impact on the PDT market short term, but I know it's going to rebound eventually. It so happens that Germany, a few years ago, the healthcare minister at the time put up a really fascinating regulation that is exactly this. If you have a robust digital therapy and you do a strong randomized clinical trial to show that it works and it's regulated as a software, as a medical device.

Basically, the medication authorities like the FDA in the US but in this case called BfArM in Germany, they authorize this therapy on a market allowing doctors to prescribe and then every health insurance company reimburses if you have that infrastructure. This is now a pretty big market.

Last year, like you said, we were so fortunate to be able to team up with a tier team, a really great group of people based in Hamburg in Germany. They have a product, their first product was for obesity, achieving 8% weight loss. Over 12,000 German doctors that are prescribing over 70,000 prescriptions. Really just a fascinating team and product and a very fast-growing market.

We were excited to be able to acquire them, eventually bringing our 2,000 products into those same channels, but also bringing them into our other partnerships. As I mentioned, we have partnerships with health insurance companies, also with global pharma companies like [inaudible 00:22:48] and Pfizer and others.

All of this is, it's an interesting ecosystem and year by year it's really maturing fast and that's really exciting to be able to be working at the forefront of seeing that change happening.

Brian Urban:

That is extremely exciting. I love the use case you just shared there in Germany. It's interesting because from the US perspective, we look at our crazy landscape that is hundreds of payers across and lots of middlemen in between. Then you go into a European perspective and you see government backed insurance, you see more of a single payer system in Scandinavia countries as well.

That there's still a lot of work to be done to be able to help individuals and help physicians have a stickier relationship with the lives that they're serving. The technology is still a fit it's just different globally. There's even private health insurance plans exist in Taiwan, Taipei, India. It's still so applicable. I'm really excited for your global reach as well as the US side as well.

Something I am curious about is some of your pharmaceutical life science relationships too. I think about your tech and I see while medication adherence is a huge thing, access is a huge thing, I think about injectables at home now. Dupixent a few years ago went in home and that it could increase potential infections when you're injecting a drug and you're learning how to do that

Still, you're not going to get it right unless you are a nurse by background or some sort of clinician. I see that as the play, but there's probably so much more to it there. Can you tell us a little bit more about what the relationships have meant for you in the life science space in terms of your tech in the US?

Tryggvi Thorgei:

Absolutely, and you mentioned medication clearance. There's about 300,000 people that die every year in Europe and the US because of lack of medication clearance. It's just a huge, huge problem that we have to fix. It's way beyond just forgetfulness. It's a whole constellation of things that results in someone not taking their medication as prescribed.

It's not understanding your treatment, maybe not even trusting that it's the right treatment. Then yes, there is forgetfulness and forgetting to refill your script. Then things like you said with when it's an injectable, it's a very complex process and doing that right. That's where, again, digital health can really help. We work with our pharma partners to basically augment their pharmacotherapy with our digital therapy, meaning that we can address the patient's needs much more holistically.

If you're a breast cancer patient, we can help manage the side effects of your medication. We can help improve your quality of life, address whether it's pain or nausea or anxiety. Really holistically supporting you as a person. Yes, we will also help you adhere to your medicine and your care plan if that's needed.

In some cases, we can remotely connect you with your care team as well in our payer partnerships of course, and then also provide data insights back to the pharma partner, but in an anonymized aggregate matter to better understand the people that they're serving so they can do that in a better fashion. I think that's really powerful.

Then, you can connect these drug specific modules with payer programs so that if you have, let's say a cancer program with a payer and then a patient is on a specific drug, activating a program that's also tailored to that drug can really help with side effect management. You mentioned devices, we're also working with device manufacturers, like one called Ypsomed, which is one of the biggest manufacturers of autoinjectors.

To do exactly what you said, improve the quality of your injection, just really training you on how to do it simply at home. If you have needleless it, we help train you on that and address that. Then we get the data from the device because these are often Bluetooth connected devices, and that can really also help see if you're doing it correctly and help guide. That's again how this whole ecosystem is interconnected and technology allows us to do it much more holistically.

Brian Urban:

Beautifully said, and ecosystem, it's absolutely an ecosystem of care that a digital therapeutic technology sits on top of to be able to help a patient with those scenarios that you are walking through in terms of the pharmaceutical life science space and partnerships that you have. I'm excited for your deepening in that corner of the healthcare world in the US and globally as well.

That is just tremendous, especially when you think about prevention, ensuring that we just avoid unnecessarily healthcare costs, avoid a terrible journey for a patient as well. It's just so much that you have going for you. Now, I think from at MPH, public health perspective to public health perspective, Tryggvi, I look at your tech and I say, "Wow, there's probably so much social health insights in terms of what an intervention could be for someone downstream that a care manager using your technology and a health plan might be able to really take action on."

In terms of some things you're doing in the future, are you seeing addressing social determinants of health through your technology at a care manager level, at a payer on the horizon? Is it something that you're already pulling insights from and care managers are using in that fashion?

Tryggvi Thorgei:

Yeah, I mean that's one of the very crucial pieces of data that we pull into our programs both for the dashboard, for the care manager, and also just into our AI and adaptive care paths to help us adapt and tailor the program to the members' needs. We adapt the content, the reading level, and just a whole bunch of things that we can adapt based on where is this member coming from?

Maybe that's one of the benefits of working in Europe is you have to hyper localize. We've worked in about 10 different European countries and we have to adapt cultural factors and language and even going from German, or sorry, German to Swiss, German to Austrian, even just the accent can have an impact if it feels relevant in engaging it.

Social determinants has such a huge impact on health. It's one of the very important data points that we already are pulling in and gradually can do so much more with. For example, with AI where can help us shape the tone of voice and the message and the reading level and all of these things that can really be important in terms of tailoring it.

Brian Urban:

Wow, that's a big deal. I think about the disparities that exist across the US community to community, street to street, and having the right cultural competency and understanding of their struggles and doing it with the right tone, pitch, word choice that makes a huge deal when you're talking about tangibly improving trust back into someone aiding from a healthcare perspective.

I didn't even think about that being integrated in your tech right now. You're so ahead of the curve because when I look at all the influence NCQA has had on CMS in the US where they're at with social needs screening, I think it's a great step, but we got to fast track this thing if we're actually going to do some good in our lifetime.

The payment structure of it, do you see your tech influencing the payment structure from not only what you're doing now from a clinical perspective, but from a social needs perspective? Do you think your tech might one day have the influence of moving policy forward to get people paid for incentivized for addressing social determinants of health? Do you ever see that happening with your tech?

Tryggvi Thorgei:

Well, I think at least we can be a big part of this shift, and to me it also relates to the whole shift towards risk-based and value-based care. To me, again, as a public health enthusiast, I think that's such a critical element because what are the reasons preventive medicine and care has struggled is often healthcare doesn't have the right incentives for that.

When you shift to value based or risk arrangements, it completely flips around. Then all of the incentives are keeping people healthy and out of the hospital, which is exactly what we want to do as a healthcare system, and our technology has exactly the tools to do that. If your provider or payer, you're shifting towards that arrangement, you need to have the best tools to allow people to self-manage their condition at home.

To fill care gaps, adhere to their care plans. I mean, the outcomes that we're seeing with our payer partners are amazing. We're seeing 25% to 40% improved clinical outcomes. We're seeing 40% to 66% reduced hospitalizations, ER visits, including for cancer patients and thousands of dollars per member per year on average in cost of care savings in many of the partnerships that we're working at.

This is just essentially, if we're going to be able to shift to value-based care, this is the type of toolbox or tools in the toolbox you need for that. I'm passionate about being able to help make that shift because that is going to create the business case for more prevention, which is what we need in healthcare.

Brian Urban:

I love that you shared that particular phrasing. We're going to help with the shift in terms of being paid for value, not just volume. It's amazing, if I think about your technology, if this work that you're doing now and many other great health technologists across the globe, if this would've existed maybe back in the nineties at least for the US landscape, then global capitated lump sum risk bearing arrangements probably wouldn't have failed as fast and as dramatically as they did.

Then you fast-forward to 2008, 2010, reform of President Obama's influence on going from volume to value payments, and were straddling that in the US, but if we would be helping our physicians, not just pushing them harder and educating them and giving them the right tools, there would be less hesitancy. I think we're still so far behind the curve.

If we're going to be a part of the transformation, I'm glad that a lot of technologists like yourself exist, that's just beautiful to hear. Tryggvi, I want to take a look into the future here. Five plus years down the road, you're 15 plus years old now as an organization, what's going to be your greatest contribution to the healthcare ecosystem globally and US? What do you think Sidekick Health is going to be contributing toward at that time?

Tryggvi Thorgei:

Well, and you mentioned kind of the previous 20, 30 years it's been happening, it's gradual. I think the first wave of some of these digital tools just weren't good enough to really have the impact that we needed to have the shift, but that's happening really fast now. Again, it's such a privilege to be working in the space in this inflection point.

I think in the next 5 and 10 years, we're going to be able to massively shift from this reactive healthcare to being much more proactive. We're going to be able to work with our patients and our members in a much more holistic fashion and really be able to break away from the brick-and-mortar and the office hour way of working with people and bring healthcare into your palms in your living room, really in the comfort of your home.

With that, we're also going to be able to increase the scope because currently the unscalable way that we're delivering care management is only reaching maybe 1% of our population in some cases, but we're going to be able to scale that to everyone who really needs help dealing with their condition. We're going to be able to offer you a tool to do that and to remotely connect you with your care team.

By doing that, we're going to be saving eventually millions of lives, which is what really motivates me. We're also going to be using resources in healthcare so much better this valuable time from these amazing healthcare professionals. All the money that we're putting into this, we're going to be using that where it's really needed.

That's to me, the only way we're going to be able to also deal with the ever-growing needs in healthcare with a growing population and such. For us to be able to be at the center working with amazing partners who are, I mean, we're working with a quarter of the 20 biggest healthcare companies in the world, be able to do that at this point is a dream to come true.

Brian Urban:

That is truly a dream come true. I could not imagine the feeling you have every day doing the work and having the impact that you have visibly, it's just fantastic. Thank you so much, CEO of Sidekick Health, Dr. Tryggvi Thorgeirsson. Thank you for joining our show here today.

Tryggvi Thorgei:

Thank you, Brian. My pleasure.

Brian Urban:

For more exciting insights and excerpts, please visit us at finthrive.com.