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      Healthcare Needs a GUT Check...Literally!

      Healthcare Rethink - Episode 81

      "What if the future of GI care is already here?" This question beckons an exploration into gut health in the latest episode of Healthcare Rethink, a FinThrive Podcast. Host Brian Urban brings two visionaries into the conversation: Dr. Austin Chiang, a pioneer in endoscopic technology and social medical education, and Sam Holliday, whose company, Oshi Health, is reshaping the approach to GI conditions with its virtual care model.



       

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      Brian Urban:
      Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban. Today we are giving healthcare a gut check, literally. We have brought on for our episode here today CEO of Oshi Health, Sam Holliday, and chief medical officer of endoscopy at Medtronic and newly found author as well, Dr. Austin Chiang. Thank you both for joining us here today.
       
      Dr. Austin Chia:
      Thanks for having me.
       
      Sam Holliday:
      Yeah, thanks. Excited.
       
      Brian Urban:
      This is going to be a lot of fun. You both lead a lot of work in this space from a device, thought leadership research, virtual care model perspective, so let's dive right in. I think our audience is very appreciative of getting to know our guests off the top here. So let's start with you, Austin. So you're the first chief medical officer of endoscopy, specifically under Medtronic, and your path wasn't just waking up and becoming a chief medical officer one day and having your MD and your MPH and becoming an author. What's your path to how we're seeing you here today? Tell us the story of how you got into healthcare.
       
      Dr. Austin Chia:
      Yeah. I mean, I think that early on I identified an interest in medicine and found my way to gastroenterology. It wasn't my initial intention at first. I kind of had to explore in medical school and throughout medical training, and eventually found my way there and pursued multiple fellowships in bariatric endoscopy, which is weight loss procedures done through the mouth, but also advanced endoscopy, which just more complex procedures mainly around the pancreas and biliary system, but a lot more to that. Had originally pursued a purely academic track and was approached by Medtronic two and a half years ago, and thought I would take a chance in exploring something different and being kind of the only gastroenterologist, I'd say, at a major med tech company and then go from there. But I said I would only do it if I continue practicing, so I still do practice part-time at an academic health center in Philadelphia.
       
      Brian Urban:
      And it's amazing because you have research chops and you've continued that into your authoring work. I think you've actually continued that nicely into the social media world as well. I know you have quite a following. So it's exciting to see your visibility and the education that you put out there and albeit a fun digestible way here for the audience. So, just so excited.
       
      Dr. Austin Chia:
      Yeah. Thanks for mentioning that. Yeah, no, I think it's always been a passion of mine, is trying to reach the general public and helping empower everyone with good, accurate medical information because otherwise there's a lot of misinformation out there as we all know. So that sort of social media journey has been a decade in the making, and I've worked with the social media platforms directly and started a nonprofit to help educate other health professionals in using social media for this sort of purpose, but it sort of snowballed in a way that I didn't imagine it ever becoming, but it's been an interesting journey and an important one too.
       
      Brian Urban:
      Yeah, an important one. It's lovely that you've had fun with it, and I think that's the attractive piece of what you're putting out there in terms of content and getting a understandable level of what gut health is and how it's interconnected to everything that we do and experience.
       
      And Sam, speaking of education, high touch, high frequency is a large part of your virtual care stack and your model, the technology you're bringing to the market. You didn't just wake up becoming CEO either. You had a really interesting path to this. You have a great team. We had Randy Foreman on the show here before. Tell us how you got into healthcare and how we're seeing you as the CEO of Oshi Health today.
       
      Sam Holliday:
      Yeah, sure. Thanks for having me. I've been in healthcare my whole career. I've done a bunch of different things, worked at an electronic medical record company, sort of learned about the tools physicians use to treat patients and run their businesses, worked at a company that helped health systems with patient acquisition and figuring out patterns of referrals between physicians. But then got into diabetes. I was working where we were delivering care via the phone to people with diabetes, and we were using food as an intervention, we were prescribing and helping them manage medication. And I got really intrigued by using food as an intervention.
       
      My mom ended up getting diagnosed with irritable bowel syndrome. She was told about the low FODMAP diet, which is a pretty complicated diet to figure out by yourself, but unfortunately all she was really given when she left the office was this handout. There's not a lot of time for a physician in a visit to unpack the gut brain connection or how food might be impacting conditions. So she had to go sort of figure this out on her own. And she did that. I learned about low FODMAP at her dinner table, just watching her pull out the sheet about which foods were high, low, medium. She redesigned all her recipes and when she told her gastroenterologist in a followup what she had done and that it had gotten the results, he was sort of blown away. He said, "Wow, I tell a lot of people about this. Very few figure it out. What did you do? You should start a company helping other people implement dietary interventions for GI."
       
      So she tells me the story and I'm like, "Wait a minute, there are people doing this in diabetes. I wonder if we could build something in the space." My sister lives with Crohn's disease, so on the more severe side, and her struggles had always been behavioral. So the mental health side of both living with that condition and the toll it takes, the impact it has on your relation with food. There are a lot of eating disorder challenges that developed depression, anxiety. So I knew her struggles and really it all came together when we realized that we could put all the parts together that someone needs to get better and we could scale that with virtual care. So that was really the genesis of Oshi Health in the story.
       
      Brian Urban:
      I did not hear this type of detail before when learning about the birth of Oshi Health, and I love you for sharing that, especially regarding your mother and your sister. I think a lot of great leaders that we speak to on the show have that common thread of something personally touching their lives and them wanting to contribute toward more people and helping them avoid struggle, avoid pain, and become healthier in their life. And I can absolutely identify with that. I've had challenges with IBS my entire life. Thankfully I've avoided a lot of unnecessary procedures, but I've had to radically change my lifestyle and I fought against it the whole way through. But we're very susceptible to it in the American society here in terms of consumer behavior, what's available to us, and so on that we're going to get into.
       
      But Austin, let's get to you here to ground us in terms of defining gut health. You have a really awesome book coming out called Gut Health: An Owner's Guide. I pre-ordered, it's dropping April 9th. So very excited for you to be able to go on this tour. Oh, there it is. I couldn't get one in time. Amazon actually isn't that fast enough, so that's awesome for you. I'm so excited to dig into it very soon. But let's start high up here. Many trends, diet, wellness, uncovering specific foods, and a lot of food science studies now that are helpful for finding a good balance between mental health, behavioral health, and physically feeling good. But what is gut health? Define that for us that we can jump off from here.
       
      Dr. Austin Chia:
      Well, I mean I think that this is, first of all, I want to say what the work that Sam is doing with Oshi is amazing. And I think that's part of the challenge, is healthcare in general is we have to also think about the time patients are spending outside of the clinical encounters that they're having with their doctors in a hospital or in office because that's the majority of time people are spending taking care of their gut. But what it means to take care of your gut, I think it's just so multifaceted because there's so many different organs involved. And I think often when people about the gut, they think of this long tube, something intestinal, but really there's so many other organs even within that tube. There's the esophagus and there's the stomach. And within each organ system, there's just so many conditions that could happen. You don't really appreciate it until something goes wrong.
       
      And then on top of the tube, the food tube, there's also the liver and the pancreas, and all of it sort of comes together in so many different ways, not just to help digest food but also just regulate our normal bodily function, whether it's the gut hormones that have received a lot of attention, especially when it comes to weight loss lately, the gut microbiota, which we are still learning a lot about right now. So it's very complex and I feel like part of the reason why it's receiving a lot more attention these days is that we're learning more and more about, and there's still so much more to uncover because right now a lot of it still remains a mystery.
       
      Brian Urban:
      It's fascinating that we've existed in a food-centric society for so long, yet we know nothing downstream about the impacts. Food as an intervention into what Sam has built out in a virtual care model is fascinating. I wish your model had existed 50 years ago. We would've substantially shifted costs in our healthcare economy and just probably had a lot more healthy and happy people.
       
      And with that definition as a grounding, thank you, Austin, Sam, I want to get to Oshi Health and understanding how you're addressing this axis of gut health brain connection here because we have a huge challenge in terms of what we talked about briefly yesterday, simply having enough gastroenterologists in the marketplace in the US. So there's a lot to unpack with Oshi, so bring us up to speed. Take us through it right now with the latest and greatest from Oshi.
       
      Sam Holliday:
      Yeah, absolutely. Our goal was to make it easy to access all of the providers you might need to solve the symptoms you're experiencing, the GI symptoms, put them all in one place. And the way to do that, there was a clinical trial that had put dieticians, psychologists in a brick-and-mortar clinic in Australia actually, and shown that care model where you have gastroenterology providers with dieticians in psychologists that know these interventions really worked. It was easier to access because it was all in one place. They were truly working as a team, and they got great outcomes, better outcomes for the patient, lowered the cost of care and it was easier to access, but it's not scalable when you're trying to do it in a brick-and-mortar environment. Telehealth really enables us to scale access to the parts that are essentially missing in the US, which is the dietary interventions and support for those and the gut-brain intervention.
       
      When the signaling between your gut and brain is dysregulated, it can cause these symptoms. When you're feeling these symptoms, it can drive anxiety, depression, social withdrawal. So it is a two-way street. We don't have enough GI specialized dieticians or psychologists in the US. Well, telehealth lets us really scale their ability to see people regardless of geography and to see them more frequently. A lot of this is test and learn. We don't have precise testing for what is going on, specifically triggering symptoms for a lot of these conditions. It takes a little experimentation around which foods might be triggering it. Do you have a gut-brain element? And then trying the interventions that we know work with the support of an expert.
       
      We do that in Oshi. Every two to three weeks, someone's meeting with our clinical team, could be a dietician, could be a psychologist, could be both, all overseen by a GI doctor who's sort of monitoring everything going on. And we iterate until we figure out symptom causes and solutions. And that's really the model. The magic of it is, when you get symptoms well controlled, that's what drives cost savings because when you finally help someone get this under control, they stop seeking out answers, right? People living with these conditions are very motivated to find help because it's getting in their way every day, both with their life and with their work. So really we built Oshi to get the symptom control with a multidisciplinary team that's easy to access.
       
      Brian Urban:
      Wow. And that's so upstream compared to a lot of what healthcare delivery models are in the US which is acute or urgent or emergent in nature. So I love that because it's high frequency and high touch that you mentioned as well. The other thing that's really interesting is the innovations that are blowing up in the space in terms of early detection for really complicated scenarios in GI, and a lot of that you've touched in a hospital setting or space, Austin, but I'm curious of one thing that Sam mentioned in terms of gut-brain health psychology as that is a part of I think a critical curriculum piece in medical education. You have an MD and an MPH, we share a little bit of some brain space there. Not on the medical side for me. But I'm curious, of your academic adventures, was this ever a core piece in your learning, the bio, social, psych piece of food as an intervention related to gut health?
       
      Dr. Austin Chia:
      I think that when I was going through medical training, that was years ago, and I don't think that our understanding was quite as mature back then. So naturally, I don't think that it was emphasized quite as much, but I think that I caught the initial conversations around it. It's hard for me to say nowadays whether or not it is truly incorporated in medical education. I want to say that likely it probably isn't quite as much as it probably should be because medical education lags a little bit when it comes to talking about really what's cutting edge at the moment. But I do think that it's going to become a bigger part of the curriculum, and as, like I said, we're uncovering more with every passing year, that it'll become a standard when it comes to medical education pretty soon.
       
      Brian Urban:
      Yes, and hopefully a standard of care as well. Let's stay with you for a second, Austin. I was doing a little bit of research into which I'm not very familiar in terms of the total addressable market on the business side of healthcare related to GI, and the global market looks at about $36 billion that can be captured in terms of treatments and tech and device for helping a lot of people that are struggling with undetected GI challenges. So I looked a little bit further. In the US alone, it's about 26 billion in terms of the opportunity to grab.
       
      And then I'm thinking about these numbers I looked at and then I look at the innovations coming out of Medtronic, the GI Genius, it's a device purely, I believe, made for early detection, but it's so big and it's so eye-opening now more than a lot of other niche diseases and health challenges across the ecosystem. I'm curious, with these numbers I threw out there, are we seeing the rise in GI challenges because of aging populations, because of dietary consumer behavior, market flooded with just really bad choices? What's maybe the cause of the rise here in focusing on GI health across the healthcare tech space?
       
      Dr. Austin Chia:
      Yeah, I think that's a great question. I think just looking at the procedural side of GI alone, I think my personal opinion is that yes, the aging population probably has to do with part of it. I think that increased screening that comes with that and procedural volume for sure. I think that the advancements in technology when it comes to making things less invasive is a huge part of gastroenterology and what attracted me to this field in the first place. And I think over the past 10 years, probably more, we've really seen that come to fruition. I think just looking at Medtronic's endoscopy business itself, this wasn't an independent unit within Medtronic until recently because it took that much time to really find its own.
       
      And I think that on top of making things less invasive, to your point about GI Genius, AI is becoming a big part of the conversation these days. There's so much that AI could be applied to. Polyp detection with GI Genius is just the beginning of our vision with that product. And you can imagine that there's so many other aspects not only in the colon but across the GI tract and other parts of our portfolio that you can apply AI to, that there's just so much more that we can actually apply AI to help with improved detection and prevention of downstream illness.
       
      So yeah, very excited about that space. I think part of it is not only the aging population, but to your point about cancers developing maybe as a result of our dietary habits, I feel like our understanding of food and the gut has changed. It's very dynamic because our food has also evolved over time as well, but we are seeing a rise in colorectal cancer year after year, especially among people who are younger than 50, which is why the guidelines for screening have changed. I think it was three years ago where the screening age was adjusted from 50 to 45. So if anyone listening is turning 45 and you don't have any family history or underlying conditions, you should get screened for colorectal cancer then. And again, we're seeing even younger people develop colorectal cancer too. So time will tell whether or not we need to continue adjusting those screening recommendations. But all those things combined I think are what is contributing to that growth in addressable market.
       
      Brian Urban:
      And it's fascinating to hear you talk about that breadth and the viewpoint that you have in the marketplace is just really helpful. And I think it's interesting because we're talking economics here and even down to the unit, the individual here in terms of early detection, screenings being so helpful. I'm glad you said that message, Austin, of if you are in that 45 range, get yourself checked in terms of colon cancer screenings.
       
      So thinking about the economics, one facet of, Sam, Oshi Health that I am really interested in, I'm thinking about inflation right now, all the different challenges that an employer group has, want to get into the success of employer group work that you've had at Oshi because a lot of your work is, again, having that earlier detection and high-frequency touch and complementing a lot of healthcare physicians that are in a physical location. So tell me about some of the work that you've been having with employer groups specifically.
       
      Sam Holliday:
      Yeah, sure. And just to pay back on what Austin was saying there, it is really important that people go get screened for colon cancer. My dad died of colon cancer. This is my other personal connection. So I went early, I went when I turned 40 to get screened. I did colonoscopy. I also just want to give Austin a shout-out. He's done some really important messaging on social media to clarify some confusion around whether colonoscopy is effective. There was a study that came out that was pretty misleading the way it was reported, and Austin did some important work to clarify that in simple terms for people that colonoscopy is absolutely the gold standard way to get screened for this. It is effective, and it's good and important that we lower the screening age in the US to 45.
       
      So what that's done is, it's created a lot more demand for colonoscopy and for other screening modalities. And that's keeping the GI docs very busy. So I think they're very focused on how do we keep up with all the volume of colonoscopy, endoscopy, both for screening for cancer, but also for diagnosing conditions, making sure there isn't Crohn's disease, ulcerative colitis, Barrett's esophagus going on. So the procedures are really an important part. It's what the GI community is really working hard to do, is to make sure they have enough capacity to serve all the need.
       
      Where we step in with Oshi is a lot of the follow-up care. You asked about employer, 29% of most of the employers where we look at the data, 29% of their population has a GI condition. And these things do develop earlier in life. So this is not just a Medicare age issue, this is happening in crime of people's working careers. The costs are going up. Some of that's really good spend on colonoscopy, and that's really important. There's a lot of medications that are used in IBD that are expensive, but again, very effective. What we focus on at Oshi is where are there things that are avoidable, that are happening because the person suffering is not getting clear answers around what's causing this and what can I do to actually keep this down going forward.
       
      So I think employers are starting to pay more and more attention to this category of spend. We've done a lot of work to look at the claims data and show them parts that they had been missing. And I use my mom as another example here. She got really well controlled for a while, then had a stressful life event, and that cognitive side triggered a big bout of constipation and abdominal pain. She wasn't able to quickly get into see her GI, and they said, "You should really go to the emergency room." Now, it was because they couldn't fit her into the schedule. It was also because they didn't want the liability in that moment. So they sent her to the emergency room, CT scan, imaging, held overnight for observation. GI is the number one reason for treat and release ER visits.
       
      So that whole episode she went through never got tied back in the claims data to the cause, which was irritable bowel syndrome. It just got coded abdominal pain. So what we've done is really use claims data to better show the employers what this is costing and which portions of that could be avoided if we, to your point, can get the symptoms really well controlled. And in that moment for my mom, she can get on a very quick call telehealth based or just the phone to a team that already knows her well enough to say, "Unless you see these alarming symptoms, you're okay to stay at home. If you see those, call us right away because you might need to get into the emergency room." And that's a GI doctor who's on that call, who can respond in real time.
       
      Those are the ways that we drive savings, is both keeping someone controlled so that those moments don't happen as often, and then when they do happen, if it's safe and appropriate, supporting people to stay at home, use tools they have or can get at home to keep it down. So employers are definitely focusing on this category in a bigger and bigger way. We've run a clinical trial to show that we get great outcomes. The clinical outcome we measure most is symptom control that I've been describing. 92% of our patients achieve symptom control usually within four months. It can take up to 10 visits with our care team, by the way, that's the average to achieve symptom control. So this is very, to your point, high touch. And then it saves a lot of money in avoiding these ER escalations and the imaging and other things that happen. So we have saved over $11,000 in nine months in that clinical trial. So that's the other reason employers are starting to say, "Okay, we need to be doing more to control this cost."
       
      Brian Urban:
      I love the metrics you threw out there because that's real, it's measured ,and it's a true impact on the balance sheet. So I think the interesting thing that you described, it's nailing the healthcare basics, the timeliness of care and someone having more education on their body and their health with the symptoms that you talked about, being able to manage them and identify them through someone who knows them well and is not in line with almost, I guess, basically a endless line for GI physicians to see.
       
      So I love that, and you both make me think where you're going. I think pathology in terms of Medtronic, the detection of things early through device and AI, and sharing data, and then even looking beyond claims data too, understanding who has access to healthy foods, transportation things, challenges that's more socioeconomic data related that can blend with clinical data too and how it's captured and shared in a meaningful way. I just see both your organizations and your thoughtfulness just blowing up in the next several years. I love it. I'd be remiss if I didn't hit Austin up with a couple book questions. So it's not out yet. April 9th, again, is when it drops. But anything you can tease us with or giving us some context into why authoring a book right now, I'm curious of how this came about.
       
      Dr. Austin Chia:
      I think you teed it up pretty well in that what my purpose in doing this is really to educate patients and help empower patients to be more informed and make the most of their time seeing their doctor and ask informed questions. I felt like a lot of the books out there do touch on various aspects of gut health, but this is really kind of a complete overview. And not only is it an overview, but it's also in color and illustrated, and so it's a little more digestible. I think part of the reason why the publisher approached me in the first place was they wanted to take my social media voice and see if I can put it in print form.
       
      One thing obviously as an interventional GI I cared a lot about is sharing the procedural aspect of things and sharing the history of gastroenterology and helping understand how this field even evolved to be what it is today. Especially when it comes to procedures, because I see patients who come into the hospital or the clinic, it can be an intimidating experience and it can be scary and unfamiliar, and I want it to help familiarize the experience even down to what is the doctor doing to you when they're trying to tap on your belly or what are they listening for, who are all the people in the room or who you're going to be encountering along the way. Because it's not just the doctor that you're going to be talking to, you're going to be speaking to dietitians and medical assistants and other folks who are involved in your care.
       
      Procedures are also something that are complex often and not touched on, I feel like, in a lot of books aimed at the general public. So describing what these procedures are and exactly what we're trying to do with them I think is something that I wanted to demystify with this book. So it touches a little bit on every aspect of gut health and to the point of demystifying things. There's also sections with each chapter debunking common myths and questions that people bring to me. So hopefully it'll help with that entire experience of navigating your gut health.
       
      Brian Urban:
      I'll take it. That's a pretty good tease for interested readers out there in our audience, let alone the rest of the healthcare ecosystem and those that focus on GI health, gut-brain connection. I love it. And I think what's so exciting is the visual nature. The illustrations are going to be very helpful for people to pick up and understand. And then also the navigation that you provide too is, why are some things done for you by a physician and what does that mean in terms of a care plan? So that's probably extremely helpful for a lot of folks that just don't know. They go in and they come out, and they just purely listen to what is prescribed to them.
       
      Sam, I saw you nodding your head there as Austin was talking about common myths. So as someone who has grown this startup company, Oshi Health, that is becoming very successful. You're getting past a traction point. You're really helping a lot of lives, a lot of stakeholders in the industry. Anecdotally, you hear a lot of things from the lives you serve. It's very visible on your site and the content you put out there, about the people that you're helping and how you help them. Is there a common myth or a common misconception or theme that you're seeing a lot of the lives you serve present whenever they're starting to get care from your virtual model?
       
      Sam Holliday:
      Yeah. And it does really relate to what Austin just shared. I mean, I think the good news is, stigma is lifting around GI conditions. People are talking about this on social media. Gut talk is a big TikTok trend and channel. But to Austin's point earlier, there's a lot of information that's not necessarily accurate. And in GI also, so much of it's personalized. All three of us could have irritable bowel syndrome, but we could all have completely different triggers. So what works for one person that they might share online, the odds that that exact same thing works for somebody else aren't super high. And I think it's important for people to understand that personalization that's needed.
       
      Education is one of the biggest things we do, and listening. Our first visits are 45 minutes. We try to track down the patient's records before that first visit and our providers actually taking the time to look through them to inform the conversation they're going to have with somebody. The number one feedback we get from our patients after that first visit is, "Wow, this provider listened to me. I felt heard, I felt understood. I felt like I learned a lot about what is causing or might be causing this, and I feel hope that we might finally have a plan and a path and a team that can help me get better." And I think that sort of hits on the need for education. We do a lot of it. We do it live, and then we'll send people content as a reference. So maybe we'll start prescribing Austin's book. But we do a lot of that education.
       
      Yeah, we do a lot of that education just to try to help people understand because also the more you understand what's going on in your body, the better you are set up to then control it going forward, to know which things are potentially really serious and which ones might not be. But that people will feel like might be really serious, because when you have a certain type of pain, you're going to take that very seriously, even though there might be a very logical cause for it, this might be a normal part of the condition, but the knowledge that, "Okay, this is normal. I'm going to feel this once in a while. I can use breathing techniques to call my nervous system, and I can see if it resolves, and if so, I'm okay." Whereas maybe in the past they would've catastrophized that situation and said, "Oh my God, there's something really wrong," which then just sort of strengthens that signaling and you feel it even more. So that's an example of the education and then the tools, the cognitive tools that we give people to better control the condition so it's not controlling them.
       
      Brian Urban:
      I love that you phrase that we are very good at listening, and that's the number one piece that you hear from your patients. And I'm curious, from everything that you laid out there, Austin, in your purview of next generation, device, AI, the whole virtual digital world that we're moving toward healthcare, how do we balance that between the in-person and the tech that's going to contribute toward more trust, a better experience so we can have better clinical journeys, better clinical outcomes? How do we balance this in the future?
       
      Dr. Austin Chia:
      I mean, I think the pandemic has really accelerated the conversation of how do we bring care outside of hospital systems and put the patient at the center of the conversation and make things easier for them. Because if we think about the root cause of why some things are missed or aren't followed through, why treatment plans aren't successful, I feel like often it's things that are more systemic and are involved with, just like what Sam said, about having the conversation around gut health. At one point in the past, it was less conventional, less accepted to talk about butts and guts, and now it's a little more easy to talk about it openly. I think that just even when I think about my own patients, they struggle with coming downtown to Philadelphia and finding parking and things like that that get in the way when we could easily facilitate something at home virtually.
       
      Like I said earlier, so much of patient care in the past was limited to that short amount of time that we have face-to-face, but really the majority of time that's spent taking care of your gut is spent outside of the hospital or outside of the clinic space. So how do we harness that time spent? So I think that there's huge opportunity here, and I think even from a med tech side of things, we're trying to think about which of our technologies can we have more centered around the home. A couple of years ago, for Medtronic's endoscopy business, we actually received FDA approval for home ingestions of our PillCam, capsule endoscopy device. It's something that I think potentially we can figure out a way to have patients administer that study themselves at home. So yeah, we're also thinking of ways to make the patient experience more comfortable, easier to understand to get them to better health outcomes. So it's not just the technology in and of itself, it's also kind of everything around it.
       
      Brian Urban:
      I like where you took us there, Austin. It's changing societal norms and conversations foundationally and doing that through a lot of influencer-type modalities, but then also in-home care, listening, the simple basics of nailing what a healthcare experience should be for a human. It's going to take all these things. And then the in-home testing kits as well, that's where I see a lot of screenings going. You see Exact Sciences doing that. You see a few other pathology companies doing that, advancing bench science with it. It's amazing. So I love that you took us that direction. I didn't think you would. So hey, let's round up the conversation here with a big finish. I want to get a five plus year outlook for our audience here with our two leaders. Let's start with you, Sam. What are some big innovations or trends that you see happening in GI Health over the next five years and maybe what is Oshi Health going to contribute toward as well?
       
      Sam Holliday:
      Yeah, I mean, I mentioned it earlier, there's going to be a shortage of gastroenterologists. We just don't make enough new ones to replace retirement wave that's coming and the burnout that's happening where people are either leaving practice or reducing their hours, which makes less availability. And there's a really important function of a local gastroenterologist to do the procedures, right? Yes, there's PillCam from Medtronic, but how much that can scale to actually help solve this problem, we don't know. So the gold standard colonoscopy and making sure people have access to that quickly is going to continue to be really important.
       
      What we want to do is actually step in and complement the care of that local gastroenterologist. So if they determine that you have irritable bowel syndrome or any other GI condition that might be conducive to dietary or gut-brain interventions, that we're their partner, right? We're a seamless extension of their to refer back and forth. Or if someone starts their journey with Oshi, we determine, "Hey, they actually need a colonoscopy. We've done the work up. They really need to get in and be seen," that we have agreements with local GIs to be able to get our patients in quickly. It's a GI to GI referral open access type procedure.
       
      So we just want to make this all as seamless as possible, to Austin's point, for the patient, which things can they stay home for and when they really need to go in person that we make that handoff really, really seamless in both directions. Everybody has the information they need to do their job, and it flows seamlessly back and forth. And then the other thing I just want to highlight is, Austin has alluded to it, we're learning still so much about how our bodies work when it comes to the gut. That part of our vision for Oshi is also to be a place that that research can occur. So we want to be large enough and data-driven enough that we could be a site for clinical trials into the microbiome or new interventions, new diagnostic tests, whatever is coming down the pipe, that we can be part of that research to figure out what works and then we can implement it really quickly into our practice.
       
      Brian Urban:
      I love that. If you become a research hub, that is going to change the game entirely, aside from all the amazing vision and insights that you just shared there, Sam. Austin, let's get your take on this. Looking out in the future, trends, what's happening, what's Medtronic going to contribute?
       
      Dr. Austin Chia:
      Yeah, I think going back to the initial question at the very beginning of this about what gut health is, there's just so much to tackle, and to Sam's point, that's one angle that we're taking. But also on the tech side, from the Medtronic perspective, I think we're really committed to the AI piece of things. Right now, like I said, we have this colonic polyp detection device, GI Genius, but colon polyp detection is really only the first step, there's so much more to it. And we announced last year this partnership with NVIDIA where we were opening up GI Genius to become a platform, and we are trying to work with NVIDIA and work with the developer community at large to develop apps to host on our hardware where potentially there would be AI applications for other indications across the GI tract.
       
      I think system-wide, as Sam alluded to, trying to make the patient experience more seamless, our health system is so convoluted and complex, and I feel like AI potentially will have a role in operational efficiency, making our workflow a little more easier, especially in this climate of physician burnout. Making the jobs of these doctors a little bit easier as well is going to be a big part of it. And then the other thing I want to emphasize again is just the evolution of our conversation around gut health and how we're sort of removing the stigma around talking about the gut. And hopefully we'll continue that trend and help people be able to be more informed going into their doctor visits.
       
      Brian Urban:
      I love it. And especially when you think about how we navigate, I think a lot of our GI space and healthcare needs an owner's guide. There we go. And I know just book one's coming out, but I can feel book two, maybe an anthropological view on gut health, who knows? Not-
       
      Dr. Austin Chia:
      That might be Sam. That might be Sam's job.
       
      Brian Urban:
      There we go. There we go. Someone's got to write the next 2.0 on it. But, I love what you surmise for us there, Austin. I think that is going to really start to advance a lot of the technology. Detection, experience that we have is starting to evolve the conversation as a foundation that's going to really build this house of health for GI.
       
      So I love you both for joining our show, Sam Holliday, CEO of Oshi Health, and Dr. Austin Chiang, the chief medical officer of endoscopy for Medtronic and author of Gut Health: Owner's Guide. Thank you both for joining our show here today.
       
      Sam Holliday:
      Thanks, Brian.
       
      Dr. Austin Chia:
      Thank you so much.
       
      Brian Urban:
      For more exciting insights and excerpts, please visit us at finthrive.com
       
       

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