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“My goal would be to cover all 50 states by the end of 2022.” – Interview with Sam Holliday
Two weeks ago, Oshi Health raised $23 million from well-known investors. It reinforces the fact that the landscape of gastroenterology is shifting toward digitization.
In this interview, Sam Holliday (CEO of Oshi Health) talks about their plans to scale across all 50 states by the end of 2022. They also plan to hire gastroenterologists and partner with GI practices. Learn about what’s attracting investor interest in digitization of gastroenterology.
Don’t miss this one.
◘ Sam Holliday and Oshi Health’s journey so far
◘ “The gut-brain connection“
◘ “Technology alone isn’t going to solve problems”
◘ “The COVID-19 pandemic forced everybody to try out telehealth”
◘ What triggered investor interest in Oshi Health?
◘ “Costs in GI are increasing, but it’s not reflected in patient outcomes”
◘ “We have a strong vision and we started to prove it out”
◘ “High-touch, high- frequency care model“
◘ What is Oshi Health’s payment model?
◘ How will things change for Oshi Health in the coming years?
◘ “My goal would be to cover all 50 states by the end of 2022”
◘ Why should practices partner with digital health companies?
◘ Would they consider buying a GI practice?
◘ What’s the ultimate vision for Oshi Health?
◘ The future of GI?
◘ “Risks of the Oshi Health model?”
The Transcribed Interview:
Praveen Suthrum: Sam, CEO of Oshi health, thank you so much for being here. A warm welcome to the scope forward show
Sam Holliday: Thanks, excited to see you again and to have a chance to talk about Oshi health.
Praveen Suthrum: Yeah. Before we get started, Sam, I want to read out your profile for people to know what your journey has been like. In building Oshi Health, Sam combines his passion for redesigning health care around the needs of patients with a mission to increase access to the high- quality whole person care that two of his family members have needed to manage their digestive conditions. He’s held leadership roles across healthcare technology, and tech enabled service companies focused on improving population health. Sam lives in New York City with his family and enjoys spending time deepening his knowledge of how our bodies and brains work and cheering for the Philadelphia sports team and NYC FC. What’s been the journey like so far? For you personally, and I can see there is a personal story here and for Oshi health as a company.
Sam Holliday: I have been working in healthcare my whole career always with how do we use technology to improve care for people. I was working in diabetes, and we were scaling access so that people living with type two diabetes get access to diabetes educators sort of a rare resource, a lot of them with dietician training, or social worker training, to figure out how to better manage their diabetes. We saw a lot that food was an important part of managing diabetes and sort of, what you ate, and there was a mental component to it as well. Learning about adhering to your medications, right? All these tools that we helped people learn, and really make changes to their diet, then we saw a lot of innovation happening in diabetes around us, interesting companies like Virta health, which basically said, we’ve got evidence that this ketogenic diet can work for metabolic disease. What if we actually gave people better support implemented? I saw that innovation, and then I sort of paired it with my mom’s journey, getting diagnosed with IBS, and basically being told by her gastroenterologist about the low FODMAP diet. And the way that interaction went was, here’s a one page handout about low FODMAP, you should go check this out, you should see if you can find a dietician that that understands this that can help you, you know, good luck, come back and see me in six months and let’s see how it goes. And I think he also prescribed her medication at that point. My mom has interesting tools, she grew up with a dietician, mother, she’s an engineer, thinks analytically. So, she was able to go learn about low FODMAP and figure it out. But the interesting part is that didn’t solve the problem, she still landed in the ER twice. And when I was trying to unpack with her what happened, I started to learn about the gut brain connection. We realized she had a lot going on in life was under a ton of pressure had some anxiety, and that could have played a role in the escalation of her symptoms. She went back to see your GI after figuring out her dietary triggers. And literally, his mind was blown. And he said, you’re the first person I’ve ever told about this, that figured it out, what did you do? I heard that story, and I was just thinking about my experience in diabetes and these other care models. And that was the light bulb for me, maybe a Virta like model would work in GI. And you know, my sister also lives with Crohn’s. I’ve heard her journey, and she’s really struggled to get support that would take time to understand her if she had some unique aspects about her life, that really never got factored into our care. And there was very little focus in her care around what could she actually do day to day in her life? And what support did she need to actually get there. All of these things came together for me to see this opportunity for higher touch care in GI using technology. And so that’s really what we’ve been building at Oshi.
Praveen Suthrum: At the time you joined Oshi, there was always you know, they’re all in there was a history with Oshi, correct?
Sam Holliday: The company had been started based on some research showing it when you gave people symptom tracking tools, people with IBD between their visits, and you sort of checked in and you had this check in call, kin to what sonar MD and others are doing. There’s a lot of research that shows that that works. But people didn’t always have access to the tracking part. So there was a thesis that if we give people this tool, they can use it to better understand what’s going on for themselves, what are the what are the things that might be contributing to their success? With IBD, if we give them a lot of content, they can learn about all the different aspects that could be at play. And they’ll be able to better self- manage and take this data to their physician. What we saw when we launched that tons of interest from the patient community, I think there were 60,000 downloads of the app, where it broke down was, it was too hard for people on their own to figure out which of these things going on in their life or influencing them were triggering their symptoms, even if they could track it all. They couldn’t always connect the dots; we came to the conclusion technology alone isn’t going to solve the problems here. And pair that with the story I just told you about my mom and sister and sort of seeing this opportunity and parallels in diabetes care and other sectors, that we saw the opportunity to really transform the company from a self- management platform to a care delivery company.
Praveen Suthrum: So how long has it been since the company was founded?
Sam Holliday: The company was founded a couple years ago. I entered the mix at the end of 2019. With this completely new idea, a new business model, we really started proving out the thesis in 2020. We started this all pre pandemic, with the question at that point being- will people use telehealth and will people pay for telehealth? Then obviously, with COVID, in the pandemic, we saw that it sort of forced everybody to try out telehealth for the most part, people liked it on both sides, the clinician and the patient side. And that was fuel for us. It also opened up a lot more payment for telehealth and a lot more sort of acceptance of that as needing to be part of a care mix going forward. Because that was obviously tailwinds for us. We started seeing patients in December of 2020. And we launched our first payer sponsored program in March of 2021. We’ve been now seeing patients through that program, several 100 people, and we’re getting great early results.
Praveen Suthrum: Congratulations on raising the 23 million. Marty, venture capital companies, and also quite notable healthcare entrepreneurs and several other people. So, from that point to now, it’s been a few short months. What actually triggered investor interest in the company, or was it already there by the time?
Sam Holliday: I think investors were intrigued because they hadn’t seen much like this in GI, we have a couple companies in the space that have been innovating in GI and that’s great. But nobody was really saying, Hey, we can deliver care, we can help people get a diagnosis, we can prescribe medication, we can also fill in the gaps, the dietary and the psychosocial support that a lot of people with GI conditions need. And as they started talking to the payers and the employers, they realized, this is an emerging area, people are seeing the costs and GI in total go up over, year over year, there isn’t really a strong indicator that outcomes are getting better. I think people are starting to say, should we be doing something differently? Do we need to start to evolve, care delivery and GI. I think part of the reason we got the investment is we have a strong vision, and we started to prove it out. I mentioned we’ve seen a few 100 patients at this point, amazing satisfaction from the patient side 98% satisfied. NPS scores that are five times the industry average. But we’ve also seen people saying, in self- reported data, my symptoms are better, I actually feel more in control of my symptoms. We are estimating that, we’ve been able to actually really make a difference in costs by preventing escalations and getting people better managed, better controlled. A lot of this comes back to the parts that are hard for GI clinics to do the dietary support. This really frequent touch, we’re talking to people on average every two weeks. So, this is a very high touch high frequency care model that complements what you know the current system can do.
Praveen Suthrum: Describe the model for us.
Sam Holliday: We provide people with access to a gastroenterologist, nurse practitioners, dieticians, psychologists, health coaches in a care coordinator, that’s their team that Oshi is giving them access to. And we’re doing this in a very proactive high touch model, using all of the evidence really sort of taking the first visit to unpack, meet the person, understand what’s going on, you know, capture past records so that we understand what’s already been done what’s already been tried, and then come up with our care plan for that person. We also make sure we understand, hey, are you already seeing a gastroenterologist? If so, we don’t want to get in the way of that relationship. We want to be able to complement it. We want to be able if that person in that clinic doesn’t have a good GI dietician, or psychologist, we can be those parts we can be the between visits support that we can make sure your GI is informed about anything that we might be doing with you and vice versa.
Praveen Suthrum: Do the patients pay for this? Are they insurance or employer who pays for this?
Sam Holliday: With a higher touch model, you know, if people are having to pay coinsurance co-pays at every single touch point, when we’re asking them to meet with us every two weeks, that’s going to be a barrier to people getting this more preventive proactive care. We’re working with the plans and with the employers to pay us in a way where the patient responsibility. It’s not zero in most cases, but it’s akin to what they would get in a traditional care experience.
Praveen Suthrum: These hundreds of patients that you already saw, did they pay you directly? Or did they use an insurance card? Like how did that work?
Sam Holliday: Yeah, so for the first few months before we launched with the payer program, we did have a cash pay program. And that was really, honestly just for us to test and learn, we charge very low prices, because it wasn’t about profitability, or money. It was about, we want to see what this care model looks like in real life. We need to iterate and improve our own processes, our own systems of delivering care in this way. How we train providers? How we’re monitoring quality? Our first batch of a couple dozen patients were cash pay. And then we launched the payer program in March and really shifted our focus there. The people we’ve been seeing today have not been paying because it’s part of this program, and that that payer chose to cover the entire cost for the member. In this program, we’re actually running it as a study. We have an IRB approved protocol; we’re actually measuring the results. We’re measuring satisfaction, symptom improvement, symptom control, we’re measuring quality of life and workplace productivity impact. We will be measuring with a matched control population that cost and utilization looks like with Oshi patients versus people who didn’t come to Oshi.
Praveen Suthrum: I want to read out a quote that I saw in the press release, and it just caught my attention because it was from one of the investors. The quote says- one of the largest cost drivers in health care is spend associated with GI disorders, it manifests through specialty drugs spent repeated ER visits, unnecessary scopes, and lower workplace productivity and impairment. And then it goes on Oshi Health offers an integrative model to support GI patients across every step of their journey. Whereas before, it was such a disparate and dissatisfying experience. Found the quote you know, very, very telling. In fact, it seems to me that it brings together everything that Oshi and your team and your team of investors is doing. There seems to be a lot of frustration with the existing healthcare system. And it is broken. And you already talked a little bit about it. But I’m interested to know what that core frustration is like for you as a team?
Sam Holliday: I don’t blame anyone in the current system, right? Everybody is sort of a function of the system they’re in. We built a healthcare system that at its core, didn’t start with, let’s build it around the patient, and what the patient needs, we’ve really built it around the payment model and the providers efficiency. And so, everybody’s sort of playing in that game today. And that’s the fee for service system. Like I said, we started with what will solve the patient’s problem? How do we make it a great experience to get that kind of support, and then we’ll figure out the payment model. We’re pitching that right to the payers and the employers like, Hey, we’ve really rethought how we can help people with these conditions within the system, and then add in the parts that don’t really exist in the current system. I think the quote reflects that. When we’re talking to employers, employers are increasingly seeing GI hit that top three spend category. And those are the things that they start to put energy and money and effort toward in terms of innovation, they like to test out stuff like Oshi enrolled out to their people, and they’ll hold us accountable to actually show them that it is a better experience, it can lower total costs. There’s this very slow movement toward value- based care. And I know you’ve talked about this a bunch; you’ve talked with many of the GI leaders pushing in that direction. We want to be a tool and a resource to help the industry as we make that transition to value. And we want to make sure that it also is a great experience for the patient and that we actually get the outcomes that we need. I worked in diabetes; it was super simple. You prick your finger at home, you get a number, a number tells you how you’re doing. You can go get a blood draw and get a one C and it’s a quality measure. Comparatively that’s very simple, right? You know this in GI it, we don’t have those simple measures, and that makes it harder for people to understand, like, what is quality? Are people getting better? And really have to ask the patient and you need to check in on them more frequently than our system is designed to do. And I think the investment is reflecting that. We need to reinvent care and we’ve got an idea of how to do that we’re going to need help and support from the GI community. And we look forward to partnering, we’ve had some payers say, we should really get Oshi and a couple of our large groups together and look at value- based care and see if we can set up a test. Oshi’s model plus the large GI groups. And so these are the things we want to do. And you’re seeing this happen at MSK and other spaces. We want to help GI as it transitions to value over time.
Praveen Suthrum: It’s right like you, you build things around the patient. And don’t worry about money, because money comes later, which is what happened for Oshi, and it is a happy story. But for the private practice world that is stuck in the managed care system, almost one of the first questions like for example, if you go and say, why not try out virtual reality for IBS? Or why not try out AI in the endoscopy room? Almost one of the first questions, whether it comes up directly or not, would be who’s going to pay?
Sam Holliday: I think at the end of the day, we have to show that those things generate outcomes, and that they can reduce cost. I think the benefit we have is, all the research that we’re based on has been out there for many years, it’s just to your point, it hasn’t necessarily been appropriately funded, right, people haven’t pushed hard enough, in my opinion, to redesign the payment structure for Gi. And in part, that’s what we’re trying to do. You know, we’re anchoring it really around these dietary and psychosocial interventions that we can deliver and sort of, you know, more tightly monitoring medications between visits with the gastroenterologist, the parts that have a ton of evidence, right, the medical home model for IBD. These are the things that were anchored on, I think these new innovations and capabilities like VR, the AI, as they’re studied, and as there’s clear evidence they should be paid for appropriately. So hopefully, we’ll see that happen. I think all of these tools are needed to continue innovating and GI get better outcomes, make sure that physicians and practices are compensated for their services appropriately.
Praveen Suthrum: You have some gastroenterologist on board, is the plan to hire more GI doctors on your team?
Sam Holliday: Yeah, absolutely. As we scale especially to new geographies, we will need additional gastroenterologist to work with us to oversee the care to do visits for the patients that you know have more complex conditions and really need their you know, high level of expertise on those cases.
Praveen Suthrum: Are you becoming the Teladoc for GI?
Sam Holliday: I guess. Some ways we are in the sense that, you know, Teladoc isn’t necessarily like there’s still plenty of volume for the emergency room, unfortunately, and the urgent care centers, but now there’s a quick access option. That should reduce total cost by giving people faster access to get GI specialized care in their time of need to maybe get the parts that are harder for brick and mortar clinics to fund today, back to the funding thing. I’ve heard many GI clinics say it’s hard for us to justify the spend on hiring a dietician or a psychologist. While our whole model is built around that we may find patients coming to us for the dietary and the psychosocial where they have an alarm feature present and really do need to get in and get a colonoscopy or endoscopy. And we will we need partners to then help that patient. We’re really looking over time to build our own network of partners and each geography to work together and solve the needs. And eventually, I think, get into some value- based payment arrangements with health plans.
Praveen Suthrum: What’s in it for the practices to partner with digital health companies?
Sam Holliday: This is always the first thing that comes up when we talk, it’s the what’s in it for me. And I understand that it’s a business people are, it’s their livelihood, when you really unpack it, and you sort of get past the sort of fear that you’re going to steal my patient, we got to talk about it. That’s the fear that comes up naturally, right away. And that’s not what we’re trying to do. But when I asked questions we get at, well, what do you do when you have a patient with IBS and you’ve tried medication, it’s not working. And you know, that person needs dietary and psychological, but you don’t staff those roles. What do you do with that person? And what do you think that experience is like for that patient? You know, they’re frustrated. And, you know, some practices will say they’re clogging up the practice, because they keep calling back wanting help. I don’t know what else to do for them. When we get into that kind of conversations what if you refer those people to us, and we’re actually able to get the person feeling better sustainably with these interventions. They’re going to have a much better impression of you is the gastroenterologist who got them the help they needed.
Praveen Suthrum: A practice might think, anyway we got to go the telehealth route. So why partner? Why not build all this ourselves? If Oshi could figure it out, we should figure it out. What would you say to that?
Sam Holliday: We’ve, I’ve had that conversation, too. I think that it’s not trivial to really redesign the experience from the patient’s perspective. So sure, could you slap some telehealth tools on? Could you sort of replace a visit that you would do in person with a phone call or a telehealth visit? Yes, but that’s not changing the entire experience for the patient. It’s not adding the components of care that you don’t offer today. If you aren’t getting contracts from the payer to support, all these things, are people really going to make that investment to your point at the beginning. We’re out pushing the frontier here in terms of the payment model, maybe down the road, others will be able to benefit from that. But it’s not just slapping telehealth on the current workflow, in my opinion, that’s going to solve the needs here, really have to rethink the model.
Praveen Suthrum: Have you ever considered buying a GI practice and throwing yourself into the ring? Like this private equity money that’s consolidating GI and you can get a whole volume of patients to take care of, and maybe physicians that are part of the practice?
Sam Holliday: I think hopefully this helps people understand we’re not trying to compete; we’re trying to compliment. The answer is ‘No’. I want to scale to be a nationwide support for the patient. And let the practices really optimize their business and have people feel like they’re getting a great outcome working with a local GI like we want to partner for that. I don’t want to compete with you for the things that a brick and mortar gastroenterology clinic and ambulatory surgery center do.
Praveen Suthrum: Thanks Sam, for playing along with all these different questions. But getting back, what is the ultimate vision for Oshi here?
Sam Holliday: I think to show that we can deliver a great experience and great outcomes for the patient. And we can also make the economics attractive for everybody involved, lower total cost for whoever’s paying, whether it’s an employer, but also still have a good business for ourselves and for partner clinics. And we want to do that at national scale. We want to actually demonstrate that the outcomes are getting better for the patient. You know, that’s something that’s largely missing in a lot of our health care. And we want to make the experience much better for the patient. You know, really have them feel supported.
Praveen Suthrum: Considering all the technology trends, all the business trends in the direction of where everything is going in healthcare, and if you throw a stone that far out, where would it land?
Sam Holliday: Five years in healthcare is not far to throw a stone. I think this is the question is, when will things have true value in the payment model? I think five years ago, we were probably saying, oh, in five years, that’ll be the case and it’s not. So, I won’t be as bold as to say we will shift it entirely to value based care where people are actually compensated for great outcomes at a reasonable cost. I don’t know that we’ll get there, but we’ll move forward in that direction. I think you’ve got a lot of new colorectal cancer screening modalities coming out. And obviously, you talk a lot about this sort of warning against the procedure volume being the anchor of the of the business. I think that that stuff is going to become a bigger part of the mix. I think that we’ll see new technologies, like the VR stuff you mentioned. If a patient can learn the cognitive behavioral therapy through VR, and we have to use less human capital, and fewer visits to help the patient get that outcome. That’s an amazing innovation. What will that work for every single person? I don’t know, I think some of them will still need the human, the live human support and interaction, maybe it’ll just be complementing those technologies and sort of personalizing those technologies. I think we’ll have a lot of improvements in the personalization of the of the medications that we use, I think that will start to figure out which patients respond best to which types of therapy. I think will be an interesting data set and all that, right, we’re data driven from the from the core, we’re capturing a tremendous amount of data, we’re measuring our own outcomes over time, we’re going to start to see what works for different profiles of people that will have a huge GI data set, maybe the biggest in the country in five years. That’s part of our vision, where we could actually be a decentralized clinical trials site for anybody wanting to do research in GI. These are some of the things I think we’ll see and sort of how we also want to be a part of that innovation. That is our core focus.
Praveen Suthrum: One thing that I wanted to also ask is, what are the risks in your model? What are the unknowns here?
Sam Holliday: Everything that we’re doing has been studied in a brick and mortar care delivery. There’s gold standard research showing the impact that these each of the different tools we’re putting together can generate. Nobody’s ever actually put it all together in a virtual first delivery format. I think, what a lot of people say is, well, will it work in the way that you’re delivering it? And can you do it at scale? I think another thing, there’s not enough GI specialized dieticians and psychologists say, and I know there’s others in the industry, pointing this out. And there’s good training programs that have developed, we want to be part of that we want to help build that workforce, because they’re really important to the outcomes, and to the support that people want and need. We have a risk that we just we have to find as many of them as we can in and train them and give them a great place to work to specialize in GI diet, dietary and psychological interventions, I think it is a risk. Again, if we’re perceived as a threat, that’s not what we’re trying to do. I’ll say it over and over and over, hopefully people will eventually believe me, and they’ll want to talk to me about it. And we can have a good dialogue. But if we want to partner with GI clinics, there’s no more clear way to say it.
Praveen Suthrum: The whole objective of these interviews and everything in the writing has been to actually touch on the mindset of the industry itself. And if the mindset can shift, then magic can happen across the board, everybody benefits. Thank you so much for all these perspectives, your views, it was fantastic to learn.
Sam Holliday: Thanks for you for putting out a lot of great content I enjoy listening to all the interviews with leaders in the industry helps me learn constantly trying to learn the perspectives of the different players in the ecosystem. So, thank you for doing that and for the chance to talk about Oshi, and I hope that we can engage many folks in the industry in a dialogue in the coming year.
Praveen Suthrum: Fantastic. Sam, congratulations once again on the fundraise to you and your team. I know it involves a lot of hard work. I wish you really, really all the best and I look forward to you transform the GI care space.
Sam Holliday: Thanks Praveen.
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By Praveen Suthrum, President & Co-Founder, NextServices.
COVID-19: The Way Forward for Gastroenterology Practices