Healthcare doesn’t collapse all at once. It clogs.
Not with a dramatic failure—a breakthrough drug gone wrong or a hospital shutting down—but with something far more mundane: paperwork, billing loops, fragmented data, and workflows that feel like they were designed in a different century. Quiet friction. Everywhere.
And that’s exactly where Ryan Eder decided to build.
The Invisible Layer That Runs Healthcare
When most people think about healthcare innovation, they imagine AI diagnostics, robotic surgery, or miracle drugs. But zoom out, and you’ll notice something strange: even the best innovations struggle to move through the system.
Why? Because healthcare isn’t just a medical system—it’s an operational one.
Ryan, co-founder of LainaHealth, is focused on that operational layer—the infrastructure that determines whether anything actually works at scale. His insight is simple but powerful: you don’t fix healthcare by adding more innovation; you fix it by making the system capable of absorbing it.
Think of it like trying to upgrade a city’s transportation by inventing faster cars… while the roads are still broken.
The “Unsexy” Opportunity Most Founders Ignore
There’s a reason most founders avoid this space. It’s messy. Regulated. Slow-moving. And full of stakeholders who don’t agree with each other.
In other words: not exactly pitch-deck-friendly.
But that’s precisely why the opportunity exists.
Ryan leans into problems others overlook—billing inefficiencies, administrative overload, fragmented systems—because these are the constraints that quietly dictate how the entire healthcare ecosystem behaves. Fix them, and you don’t just create incremental improvement—you unlock exponential leverage.
It’s the difference between building a better app… and fixing the pipes the entire system depends on.
Building Where Speed Isn’t the Advantage
In most startup ecosystems, speed is king. Ship fast. Break things. Iterate.
Healthcare laughs at that playbook.
Here, moving fast without understanding the system can kill your company before it even starts. Compliance, regulation, and entrenched workflows act like gravity—ignore them, and you don’t fly, you crash.
Ryan’s approach flips the typical founder mindset. Instead of trying to outpace the system, he studies it deeply—mapping incentives, understanding bottlenecks, and identifying where small changes can create outsized impact.
It’s less like sprinting, more like chess.
The Misalignment Problem
One of the hardest truths about healthcare: the system isn’t just inefficient—it’s misaligned.
Providers, payers, patients, and administrators often operate with different incentives. What’s optimal for one group can create friction for another. That’s why even obvious improvements can take years to adopt.
LainaHealth’s strategy isn’t to fight that complexity head-on—but to work within it. By improving workflows and reducing friction at key points, they create value that aligns across stakeholders, rather than forcing change from the outside.
In a system this complex, progress doesn’t come from disruption alone—it comes from coordination.
A Different Kind of Founder Mindset
There’s a certain patience required to build in spaces like this. Not passive patience—but strategic patience.
The kind that understands:
Big markets often hide behind boring problems
Infrastructure plays take longer—but compound harder
The best opportunities aren’t always visible at first glance
Ryan embodies that mindset. He’s not chasing hype cycles or flashy breakthroughs. He’s focused on something far more durable: making the system work better.
And in a market as massive and broken as healthcare, that might be the most ambitious play of all.
Fixing the Pipes
If there’s one idea that lingers from this conversation, it’s this:
Healthcare doesn’t need more brilliance at the edges. It needs coherence at the core.
Ryan didn’t set out to reinvent medicine. He set out to remove the friction that prevents it from working as it should.
Because sometimes, the biggest breakthroughs don’t come from building something new.
They come from finally fixing what’s been broken all along.
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Chapters:
00:01 – The Hidden Crisis in Healthcare Operations
02:10 – Ryan Eder’s Background & Path to LainaHealth
05:00 – Why Healthcare Feels Broken (But Isn’t Where You Think)
08:15 – The “Unsexy” Opportunity in Admin & Workflows
11:40 – Understanding Healthcare’s Complex Stakeholders
15:05 – Why Innovation Struggles to Scale in Healthcare
18:20 – Building in a Highly Regulated Industry
22:10 – Founder Mindset: Patience vs Speed
25:30 – Identifying Infrastructure Plays Early
29:00 – Misaligned Incentives Across the System
32:15 – How LainaHealth Approaches Workflow Redesign
36:00 – Lessons from Building in Healthcare
39:10 – Contrarian Bets in HealthTech
42:00 – The Future of Healthcare Operations
45:00 – Final Thoughts & Advice for Founders
Transcript
Brian Bell (00:01:02) : Hey, everyone, welcome back to the Ignite podcast. (00:01:04) Today, we’re thrilled to have Ryan Eder on the mic. (00:01:06) He is the founder and CEO of Lena Health, (00:01:09) a virtual musculoskeletal and physical therapy company paired to licensed (00:01:12) clinicians with an AI powered web AI assistant to expand access, (00:01:17) improve engagement and modernize how PT actually gets delivered. (00:01:19) Thanks for coming on, Ryan.
Ryan Eder (00:01:20): Thanks for having me. (00:01:21) Appreciate it.
Brian Bell (00:01:21): I would love to start with your origin story. (00:01:23) What’s your background?
Ryan Eder (00:01:24): Punchline is designer turned healthcare entrepreneur, (00:01:27) but I’m from Ohio, (00:01:28) born and raised in Cincy. (00:01:29) I’m in Columbus, but been in Ohio my entire life. (00:01:32) Kind of a nerd growing up, like to draw more than I like to play sports. (00:01:36) Used to like get comic books and just draw and have been like watch like Saturday (00:01:40) Night Nick, (00:01:41) like growing up and all. (00:01:42) And then wanted to get into do something with drawing for school and ended up going (00:01:47) to UC for design architecture, (00:01:50) art and planning college of design architecture. (00:01:52) architecture and planning for industrial design product design so where basically (00:01:56) you start creating something and turn that to life and turn products so i started (00:02:00) creating products after i graduated and that’s actually where the origins of lana (00:02:05) started
Brian Bell (00:02:05) That’s amazing so what did design teach you about human behavior and (00:02:12) interaction that most healthcare operators miss
Ryan Eder (00:02:14) I mean, design is really at its core about empathy. (00:02:17) And so just understanding the world through someone else’s eyes and getting trained (00:02:23) to take complex problems, (00:02:24) break them down into solvable chunks, (00:02:27) and then reconnecting those in a way that can solve a problem in a simple, (00:02:32) intuitive way. (00:02:33) And so I think it’s... (00:02:35) A lot of people, (00:02:35) even just entrepreneurs, (00:02:36) get kind of really fixed on a single path of what they want to build, (00:02:39) what they want to put out there. (00:02:40) And design kind of lets you kind of take a step back, (00:02:43) see what’s going on, (00:02:44) evaluate it as objectively as possible, (00:02:46) and then make pivots or change accordingly. (00:02:48) And we’ve certainly done that all.
Brian Bell (00:02:50) So when was the first moment you realized that MSK and PT were both a broken (00:02:54) experience, (00:02:55) not just a boring category?
Ryan Eder (00:02:56) It’s interesting because this all started from my senior thesis in design school 20 (00:03:01) years ago in 06. (00:03:03) And so it actually started through the lens of, (00:03:05) I saw a guy in a wheelchair struggle while exercising. (00:03:08) And so it started as a concept for accessible, (00:03:10) a piece of accessible fitness equipment that evolved over the years. (00:03:14) But when I was doing the early research with that, (00:03:17) I was playing wheelchair football, (00:03:19) trying to get kind of like just immersed into that world. (00:03:21) And I fell out the back of the chair, hit my back. (00:03:25) And that actually started about a 10 year journey of like rehab. (00:03:29) Like I herniated a disc, aggravated it. (00:03:31) Yeah. (00:03:32) And I was doing, (00:03:32) I was doing the project for a while, (00:03:34) like bedridden and just couldn’t get out, (00:03:36) just do the injury. (00:03:36) And I mean, I (00:03:37) Heard it multiple times throughout subsequent years and went to a lot of physical (00:03:42) therapy, (00:03:43) did a lot of treatment. (00:03:44) It was fantastic. (00:03:45) But you also realize how hard it is to stay consistent with physical therapy. (00:03:49) When it’s in the middle of the day, (00:03:51) you got to go to the clinic, (00:03:53) you got to take off time off work or get family. (00:03:55) It’s just really challenging access. (00:03:56) And that was really kind of the first eye-opening experience of how valuable (00:04:00) physical therapy is, (00:04:00) but how hard it is to access.
Brian Bell (00:04:02) Yeah. (00:04:03) And so was this before or after Include Health?
Ryan Eder (00:04:05) This was, this was the creation of include health. (00:04:08) So yeah. (00:04:10) So what happened was it was my, it was my senior thesis, three month project in school. (00:04:15) And I just wanted to have a kick-ass thesis to graduate, get a job, call it a day. (00:04:19) So I saw this guy in a wheelchair struggle, (00:04:21) came up with this concept for accessible piece of fitness equipment that like (00:04:24) anybody could use. (00:04:25) It’s like, if you’re in a wheelchair, if you, you know, (00:04:27) standard, the dexterity issues, that kind of thing. (00:04:29) And so I did it. (00:04:31) I graduated. (00:04:32) I moved up to Columbus, (00:04:33) started working as a product designer for a design firm on the east side of town, (00:04:36) priority. (00:04:37) And I decided to enter the thesis into the International Design Excellence Awards (00:04:41) competition, (00:04:41) which is like a global competition for design firms, (00:04:44) corporations. (00:04:45) They have like a little student category, proud of it, figured why not. (00:04:48) Ended up winning gold, best in show and people’s choice. (00:04:50) And I think it was like 1,700 entries from 35 countries. (00:04:55) And it rocked my world. (00:04:57) And so that got a lot of eyes on this idea of this machine. (00:05:01) And I was able to parlay that into getting some kind of some grants to kind of push (00:05:05) the idea further. (00:05:06) I moonlit it for seven years, (00:05:08) just doing nights and weekends, (00:05:09) kind of just tinkering with this idea. (00:05:12) to where I ultimately was able to start raising some venture capital to start (00:05:15) building the machine. (00:05:16) And I think the first dollars we raised were in 12 or 13.
Brian Bell (00:05:20) Wow, okay.
Ryan Eder (00:05:22) The interesting thing here is it’s actually the same startup.
Brian Bell (00:05:25) Okay, interesting.
Ryan Eder (00:05:26) Yeah, so I’ll walk you through the kind of evolution here. (00:05:30) I mean, I learned a lot even that first go around. (00:05:32) I mean, back then, (00:05:33) I was a young buck out of school. (00:05:35) The ecosystem wasn’t as mature as it is now to where people weren’t really writing (00:05:39) big checks for first-time founders that are just right out of school, (00:05:42) right? (00:05:42) It was just a very different world then. (00:05:44) So I had to bring on folks to kind of help build around me. (00:05:48) I had to bring on someone to be like an experienced CEO at first to help me raise (00:05:52) those dollars and kind of take a back step to just kind of building the product, (00:05:57) but ultimately became to where I transitioned to CEO just a few years later. (00:06:01) But yeah, the journey.
Brian Bell (00:06:03) You’re like early to mid 20s. (00:06:05) You’re like, I’ll bring in some professionals here to help me. (00:06:08) Yeah.
Ryan Eder (00:06:09) I’ve like, (00:06:10) in my world, (00:06:10) it was, (00:06:11) you know, (00:06:11) I was able to get like a $50,000 grant here, (00:06:14) $20,000 grant there, (00:06:15) which is great. (00:06:16) Right. (00:06:16) But when it came time to like, okay, now you need to raise a couple of hundred thousand dollars. (00:06:20) People are like, I’m not going to give it to you just by yourself to just go build something. (00:06:24) You know, we need to have, you know, I’m out of design school. (00:06:27) We need to have a business plan. (00:06:28) You need to know what the hell you’re doing. (00:06:29) And like, what’s, you know, give me your financial model. (00:06:32) And I didn’t have anything. (00:06:33) clue how to do any of that then right so got some help raised some money built the (00:06:38) first machine or like a physical machine is a 900 pound machine with like a (00:06:42) thousand yeah okay and like we we built it and then i can send the like i said you (00:06:47) a video of this as well like then we built a custom mobile showroom to drive it (00:06:51) around because we knew we couldn’t get people to interact with it coming to us and (00:06:56) so we built this showroom and this was in the beginning of (00:06:58) 2013 we drove it around the eastern half of the us going to like we went to the va (00:07:03) in dc like the national rehab hospital lakeshore foundation down in alabama just (00:07:09) getting people to interact with it and it was at that time as we were doing like (00:07:12) kind of like this two week long tour (00:07:14) The machine was just like mechanically smart. (00:07:17) It wasn’t digitized at all. (00:07:19) And it made a lot of sense talking to these folks like, (00:07:21) okay, (00:07:21) this machine should be smart and should be able to just do simple stuff like (00:07:25) logging your work out, (00:07:26) tracking your progress. (00:07:27) And that’s what started the software that is still the kernel to this day for LANA, (00:07:32) but just in a very different way.
Brian Bell (00:07:33) That’s amazing. (00:07:34) So you start off like on hard mode, it sounds like. (00:07:37) This is not a software tech scalable startup. (00:07:40) It’s a hardware medical device, PT kind of business. (00:07:44) Brutal, brutal.
Ryan Eder (00:07:46) I mean, it was like 35 suppliers. (00:07:49) I had a lot of manufacturing challenges getting it to market. (00:07:51) That tour was in 13. (00:07:53) We didn’t launch it until 18. (00:07:56) And there was a point where pretty sure the company was going to shut down. (00:08:00) We got kind of the... (00:08:02) the bill of materials from all our different suppliers and it completely destroyed (00:08:05) our margins and our pricing. (00:08:08) I mean, upside down destroyed. (00:08:10) And so we actually ended up putting a pause on the company and then restructured it (00:08:16) as the machine plus the software as a platform, (00:08:20) as a service that you could essentially finance over a three-year contract. (00:08:24) And we were able to get that total contract to cover all the costs and everything (00:08:27) else with the machines. (00:08:28) And we launched those in 18. (00:08:30) And so like the very first customer was the Cleveland VA clinic, (00:08:35) their spinal cord injury clinic. (00:08:37) And it was just me and my brother installing this 900 pound machine and putting it in there. (00:08:42) And I mean, it was vision realized because you had like a, (00:08:45) The quadriplegic veteran was the first person to use this machine, (00:08:48) which is why this thing was designed, (00:08:50) right? (00:08:51) And it was a really powerful moment, terrifying moment to leave that machine there. (00:08:55) But that was the start of it. (00:08:57) And then in subsequent years, we started to expand beyond machines.
Brian Bell
(00:09:01) Yeah. (00:09:01) So tell us about that. (00:09:02) So you finally get this machine... (00:09:04) It’s barely covering the costs. (00:09:06) You know, did you have to go through FDA approvals as well to kind of get it?
Ryan Eder (00:09:10) We didn’t have to go through FDA. (00:09:12) We do now. (00:09:12) We didn’t have to do it then. (00:09:14) But we had these, I mean, you got to make sure that it’s safe, right? (00:09:17) So like you’re engineering it. (00:09:19) And I was part of this ASTM standards committee where it’s all about usability. (00:09:22) And so it was like we had these design parameters where it’s like I need (00:09:27) You’ll be able to adjust everything with a single arm, (00:09:29) closed fist and less than seven pounds of force. (00:09:32) Meanwhile, you need to be like UL safety standards, like a three X safety rating. (00:09:37) So there was like, for example, there’s a seat. (00:09:39) that you need to be able to adjust for those parameters, (00:09:42) but you needed it to support a 300 pound person, (00:09:45) which means it needed to support 900 pounds. (00:09:47) So, (00:09:47) I mean, (00:09:47) the thing was an engineering tank that you could adjust just, (00:09:51) you know, (00:09:51) by a single finger or close fist kind of deal. (00:09:54) So there was a lot of that going on, (00:09:56) but figured it all out, (00:09:58) got it out, (00:09:59) installed it, (00:09:59) started installing them in 18. (00:10:01) And then in 19, (00:10:03) we ended up, (00:10:04) I mentioned I’m in Ohio, (00:10:05) we ended up doing a partnership with Cincinnati Children’s Hospital. (00:10:08) And they had been developing some computer vision technology and interfaces for, (00:10:14) you know, (00:10:14) injuries, (00:10:15) specifically ACL injuries for female athletes. (00:10:18) They had gotten like 10 million in like NIH dollars and all, (00:10:21) and they were looking to commercialize it. (00:10:23) And they said they thought they could leverage kind of our platform that we built (00:10:27) to kind of accelerate that. (00:10:29) we ended up partnering with them in 19 and then in early 20 like we saw the machine (00:10:35) and we knew what it could do and when we installed it in 18 people like i like this (00:10:39) but i have a bunch of other like dumb equipment around here now i want this all to (00:10:43) be smart you’re like okay well i’m never building another machine ever again like (00:10:46) that was just a horrible experience i was like i can take the brains out of our (00:10:51) machine and into a sensor and (00:10:53) connect these other machines. (00:10:54) So like we started piloting it with health partners up in Minneapolis, (00:10:57) C&C, (00:10:58) and then the Air Force as well. (00:10:59) And then we debuted it in February, (00:11:02) these sensors that were basically the expansion of our machine. (00:11:04) We debuted those in February of 20 at a big PT conference right before COVID hits.
Ryan Eder (00:11:10) right so yeah perfect and so covet hits no one gives a about smart machines when (00:11:17) you can’t get people in the clinic in the first place so we’re sitting there and of (00:11:21) course as soon as it hits no one knows is this two weeks is this two years like (00:11:24) what’s what’s happening here but it was clear that everything machine based was on (00:11:28) pause and so then i (00:11:30) Went to the board and said, I think we need to shift gears. (00:11:34) We just did this deal to get us into computer vision. (00:11:36) I think we need to shut down the machine side of the business to stay alive and go (00:11:41) all in on computer vision to not deliver care in a clinic, (00:11:44) but to deliver care in patients’ homes. (00:11:46) At that point, again, that was 2020. (00:11:48) My thesis was 2006. (00:11:50) So I spent all that time getting these machines developed and built out. (00:11:54) Yeah, 14 years. (00:11:55) And it’s like, all right, let’s shut her down. (00:11:57) And I’m the one that...
Brian Bell (00:11:57) Two years of your entire working life, your entire career at that point.
Ryan Eder (00:12:02) And that goes back to that whole... (00:12:05) That goes back to that whole designer mindset, right? (00:12:08) Where it’s like, look, I can see what’s happening here. (00:12:10) Yes, I’ve dedicated all this time to this machine, but this is... (00:12:14) This is a different world we’re navigating. (00:12:16) There’s a different opportunity here. (00:12:17) We can leverage the kernels of the software from the machines to power the computer vision. (00:12:21) And so when we did that, (00:12:23) we decided to basically go as anti-hardware as humanly possible, (00:12:27) learning from the machines and saying, (00:12:29) all right.
Brian Bell (00:12:30) Hardware agnostic, right?
Ryan Eder (00:12:31) I mean, (00:12:32) Yeah. (00:12:32) Well, (00:12:32) at that time, (00:12:33) like the computer vision was still powered by like, (00:12:36) think of like when Microsoft had like the Kinect camera and it had, (00:12:39) it was still hardware. (00:12:40) It was still hardware dependent. (00:12:41) And like Apple was off the shelf stuff rather than your own. (00:12:45) Yeah. (00:12:46) Yeah. (00:12:46) But like Apple, (00:12:47) you know, (00:12:47) was just releasing, (00:12:49) like, (00:12:49) I forget what they called it, (00:12:50) but it had like LiDAR on some of the, (00:12:52) on some of their devices, (00:12:53) but it required a specific camera. (00:12:55) I’m like, (00:12:55) look, (00:12:55) if you’re going to scale this in healthcare, (00:12:58) you can’t require specific hardware. (00:12:59) this thing’s got to run on it so we were we did we had a few different contracts (00:13:05) with the air force through their sbir program and so we were working with them and (00:13:09) they were one of the first ones to test this and so we kind of built it originally (00:13:13) around apple’s vision kit that’s what it was called just to see like you know does (00:13:17) this work with our system that kind of deal and it worked but (00:13:21) You’re not going to limit healthcare deployment just to those that are on Apple devices. (00:13:25) So that wasn’t going to fly. (00:13:26) But then Google had a model at that time called PostNet. (00:13:31) that was a browser based and on everything, wildly inaccurate. (00:13:36) Like you go to like PT, (00:13:37) like anything, (00:13:38) if you’re like laying down, (00:13:39) sitting down, (00:13:39) the model would just blow up, (00:13:41) right? (00:13:41) So I’m sitting there, you know, you’re in the thick of COVID. (00:13:43) I’m like, shit, okay, I need to get this out. (00:13:46) I wanted to run everything, but I needed to be accurate enough. (00:13:48) So I recorded a side-by-side of Apple’s Vision Kit and Google’s PoseNet. (00:13:53) And I shot it to one of the advocates at Google that was posting about kind of (00:13:58) their technology. (00:13:58) I was like, Hey, look, this is what I want to do. (00:14:00) I want to give this to healthcare. (00:14:01) I’ve got the air force teed up to test this, (00:14:04) but your model breaks, (00:14:05) falls apart here, (00:14:06) here, (00:14:06) and here. (00:14:07) Is there anything we can do and collaborate?
Brian Bell (00:14:09) not thinking Google would respond to you.
Ryan Eder (00:14:11) They did respond. (00:14:12) Jason Mayes, shout out to Jason. (00:14:14) We’re still heavily linked with him now. (00:14:17) He got back and said, (00:14:18) actually, (00:14:18) we are developing these models and would love to have a powerful case study and (00:14:23) start training them. (00:14:25) I started like two years of collaboration with Google through COVID. (00:14:28) In 21, we were featured in their I.O. (00:14:30) conference showcasing the evolution of this body tracking technology, (00:14:34) which is at the end of the day, (00:14:36) you know, (00:14:36) you’re estimating joint positions right through through a video feed. (00:14:39) But there’s literally a video of me back here in my office, (00:14:42) like doing these exercises with the dots tracking me and all that kind of stuff (00:14:45) like on Google site and stuff. (00:14:47) And we finally made it where it’s accurate enough for PT, (00:14:50) but scalable enough to run on any device and be web based. (00:14:53) So we piloted it some more at the Air Force, got really strong results.
Brian Bell (00:14:57) And by any device, you mean any laptop or mobile phone?
Ryan Eder (00:15:00) Yeah, anything with a browser and a front-facing camera.
Brian Bell (00:15:03) Okay. (00:15:05) Did you have to send the data to the cloud to actually run the inference or are you
Ryan Eder (00:15:09) that happened locally in the browser. (00:15:11) Okay. (00:15:11) So yeah, it’s nice. (00:15:12) Yeah, it’s nice. (00:15:13) So the model, (00:15:14) like they had two different versions of the model, (00:15:16) like thunder and lightning is what they call it internally. (00:15:18) And it would download that model upfront. (00:15:22) And so you don’t have a little bit of a buffer. (00:15:24) So you kind of give them like the patience, (00:15:25) the overview of what they were going to do while it downloads that model. (00:15:28) But once it downloads the model, that was the power of the tech. (00:15:30) It all ran locally.
Brian Bell (00:15:32) So it’s basically running on CPU hardware.
Ryan Eder (00:15:36) Super light, super light. (00:15:38) And there was a point in time where we were testing the boundaries of the devices. (00:15:43) I had like 40 devices here. (00:15:45) It’s like any screen size, any browser, any OS version, right? (00:15:49) And then phone, tablet, laptop. (00:15:52) Like, oh my gosh, how do you get your arms around it? (00:15:55) So we’re like testing all of these and like it, (00:15:57) it worked on everything except for the Amazon fire tablets. (00:16:01) That’s where, that’s where it broke down like a $50 tablet kind of thing.
Ryan Eder (00:16:05) Like it just wasn’t powerful enough.
Ryan Eder (00:16:07) But like the key for the experience was to have no latency. (00:16:11) So that’s where like the cloud stuff wouldn’t work is even a slight latency just (00:16:15) destroyed the experience. (00:16:16) And so it had to be real time, but run on anything. (00:16:20) So we built it.
Brian Bell (00:16:21) I’m kind of skipping ahead here, (00:16:22) but like we’re sitting here in 2026, (00:16:24) you know, (00:16:25) years later, (00:16:25) I’m guessing the phone hardware is a lot more powerful now and you can run a lot (00:16:29) better models locally.
Ryan Eder (00:16:30) Don’t need it. (00:16:31) So the, (00:16:32) a lot of people get caught up on, (00:16:33) there’s like a whole conversation in this about like 2d versus 3d data and what (00:16:38) you’re getting. (00:16:39) And oh, (00:16:39) if you got more powerful devices, (00:16:41) you can get more powerful data in our world where you’re delivering physical (00:16:44) therapy. (00:16:45) You’re really just trying to get people to move.
Brian Bell (00:16:47) Just tracking the joints. (00:16:49) And there’s like an asymptote of quality and accuracy there, right? (00:16:52) Right.
Ryan Eder (00:16:53) Like, (00:16:53) I mean, (00:16:53) you can get into the weeds of like, (00:16:55) well, (00:16:55) is this plus or minus two degrees versus three degrees? (00:16:58) And like that kind of thing. (00:16:59) That doesn’t matter. (00:17:00) At some point it’s like good enough. (00:17:01) And like, (00:17:01) you’re just eking out like little, (00:17:03) little points of classification F1 score or whatever. (00:17:06) Exactly, exactly. (00:17:07) So the thing is, (00:17:08) like, (00:17:08) when you’re treating patients with PT, (00:17:10) I mean, (00:17:10) we’re treating patients from their teens to their 90s. (00:17:13) So like you got such a wide spectrum of demographics and cases, (00:17:18) both post-op and chronic patients. (00:17:20) And so you need to make that technology as simple as humanly possible, right? (00:17:25) And run on anything. (00:17:26) So I mean, we’ll run on devices that are 10 years old, it’ll still run. (00:17:30) And so (00:17:31) What was interesting is that we originally built all this not for us to treat (00:17:36) patients directly. (00:17:37) So this was all built to hand to the industry to use in like hybrid care and (00:17:42) virtual care and like remote therapeutic monitoring was the reimbursement model (00:17:46) that came in through CMS. (00:17:49) I think it launched in 22. (00:17:51) And we thought that was the godsend. (00:17:53) We’ve got a reimbursement model to treating patients virtually. (00:17:55) We’ve got this technology. (00:17:56) We’re going to work with the industry, give them this, and then we’re going to be on our way. (00:18:00) And that wasn’t the case, of course.
Brian Bell (00:18:02) So what does in this case, clinician plus web AI actually mean in practice? (00:18:06) Walk us through kind of the patient experience.
Ryan Eder (00:18:08) And to give you the quick context is like, (00:18:11) we did it with RTM for the industry for almost two years.
Brian Bell (00:18:14) What’s RTM?
Ryan Eder (00:18:15) Remote therapeutic monitoring. (00:18:16) So it’s a reimbursement model from the payer CMS started. (00:18:20) The commercial payers did it afterwards that you could get reimbursed for remotely (00:18:23) monitoring these patients. (00:18:24) Getting it out into the industry was really challenging. (00:18:26) With the patients we got on it, fantastic engagement results. (00:18:30) Getting enough patients on it at the pace we wanted to was not happening. (00:18:33) And so we actually... (00:18:35) really hard for a PT and a clinic to change their operating model on a dime. (00:18:41) The industry is dealing with a lot of issues from just overall reimbursement and (00:18:44) what it means of your day-to-day in the clinic and documentation. (00:18:47) And now you want to add that, like it was just, you’re just taxing everybody. (00:18:51) And so we saw that. (00:18:54) And then we were working with a couple of care navigation companies and they saw it (00:18:58) too and said, (00:18:59) we need more people on your deck. (00:19:01) Would you consider treating patients directly?
Brian Bell (00:19:03) And you’re like, okay, so this is summer of 23. (00:19:05) And you’re like, now we’re considering becoming a virtual medical practice. (00:19:10) Right, and you don’t have anybody on staff that can technically deliver care, right?
Ryan Eder (00:19:15) Actually, I did.
Brian Bell (00:19:16) Okay, nice, all right.
Ryan Eder (00:19:17) Yeah, (00:19:17) and that’s the only reason it made it feasible was that I had some PTs on staff (00:19:21) that were more of like ClinOps helping other PTs, (00:19:23) but that were licensed in a large amount of states. (00:19:26) I was like, all right, we can try it. (00:19:28) And so we started trying this in summer of 23. (00:19:31) And now to your question about the model of how this works is, (00:19:33) I mean, (00:19:33) it really at its core is we’re pairing licensed clinicians with a web-based AI (00:19:38) assistant. (00:19:38) Her name’s Laina, right? (00:19:40) And so the way that this works is...
Brian Bell (00:19:40) Or Laina, if you’re from Hawaii, as we discussed.
Ryan Eder (00:19:45) If you’re from Hawaii, you can pronounce it Laina as well. (00:19:49) The way that it works on one hand, (00:19:50) it’s very similar to like traditional physical therapy, (00:19:52) meaning that like we’re an integrated medical model. (00:19:56) So that means we work directly with referring physicians, (00:19:59) primary care docs, (00:20:01) orthopedic specialists. (00:20:02) So they are prescribing physical therapy like they would for anyone else. (00:20:05) The difference is that they get prescribed virtual. (00:20:08) And so we get a referral that comes our way. (00:20:10) I mean, (00:20:11) This is old school healthcare. (00:20:12) We’re talking faxes, right? (00:20:14) Come to us.
Brian Bell (00:20:15) Literally faxes? (00:20:18) Right now, like in the last month, you got a fax?
Ryan Eder (00:20:21) I bet you we got a lot of them today.
Brian Bell (00:20:23) Oh, wow. (00:20:24) That’s amazing. (00:20:25) That’s crazy. (00:20:26) What are we doing?
Ryan Eder (00:20:28) Healthcare change is really tough for a lot of reasons, right? (00:20:33) And that’s one of the challenges and kind of the part of this journey here, right? (00:20:38) But you got to operate within this existing system. (00:20:40) At least we think that’s the right approach. (00:20:42) And then, but we get these referrals. (00:20:44) But that’s where everything changes. (00:20:45) So instead of like you getting this referral and you’re going to go call a clinic (00:20:49) and schedule something, (00:20:50) right? (00:20:51) We shoot you a text. (00:20:52) It is a self-scheduling link. (00:20:53) Just pull up here, one tap access. (00:20:55) And then you schedule your virtual visit with a dedicated PT on our staff. (00:20:59) Hop on it. (00:21:00) It’s all web-based. (00:21:00) So no one’s going to download anything even for like the virtual visits and all.
Ryan Eder (00:21:03) And so you meet your PT, you have a 45 minute session, like here’s what’s going on, right? (00:21:08) Here’s what I’m trying to do. (00:21:09) And then that PT creates this custom care plan, digital care plan based on that eval. (00:21:14) And then that’s where Elena helps out. (00:21:16) So then Elena comes in and is going to send you kind of daily reminders when you (00:21:21) have something prescribed for you to do. (00:21:22) Sometimes it’s stretches, sometimes it’s exercises, functional tests, some surveys, right? (00:21:27) It kind of just depends on the care plan structure. (00:21:29) But she sends you this SMS reminder that has a tokenized secure link. (00:21:34) So you just tap that link. (00:21:35) It opens up the browser. (00:21:37) We’re HIPAA compliant. (00:21:38) We’re a class two registered device with the FDA, (00:21:40) but you don’t have to download it and then you don’t have to log in. (00:21:42) That’s just all barriers of friction for a lot of folks, right? (00:21:44) One tap, you’re in. (00:21:46) You kind of get an overview of what you’re going to do and you hit start. (00:21:49) Sometimes you’re in front of the camera doing computer vision tracked activities. (00:21:52) Sometimes you’re responding to evidence-based surveys just to track kind of how (00:21:56) you’re progressing. (00:21:57) But what that does is LENA is basically the extension of the treating PT. (00:22:02) So now patients are able to do it when it’s convenient for them. (00:22:05) You have to take time off work. (00:22:07) They can do it after the kids go to bed, right? (00:22:09) Whenever it fits into their schedule. (00:22:11) But we collect all this data. (00:22:13) thing goes right back to the treating pt there is secure messaging between the pt (00:22:18) and patient throughout the entire time and so like if you need anything like oh (00:22:21) this hurts or i wish you could do this just ping them and they get back to you and (00:22:24) update you don’t have to wait till the next time you’re in the clinic then the pt (00:22:27) and the patient basically have a face-to-face visit once a month the rest is all (00:22:31) done async and monitoring the net result there is like an average pt episode gets (00:22:36) about eight visits we get 34
Brian Bell (00:22:40) So what is a PT episode?
Ryan Eder (00:22:42) So PT episode is how long from start to finish you’re in care.
Brian Bell (00:22:45) So you go and you started your care treatment and when are you deemed discharge, you’re done.
Ryan Eder (00:22:49) And so in traditional PT, (00:22:51) you know, (00:22:51) they want you to go to the two to three times a week, (00:22:54) every week that never really happens. (00:22:55) You know, statistically it’s about the average is about eight visits, eight in clinic visits. (00:23:00) Now for us, (00:23:01) The average number of visits, (00:23:03) this is both in clinic or in face-to-face, (00:23:05) but also like doing sessions on the app and tracking your progress. (00:23:08) So that’s synchronous and asynchronous. (00:23:11) That’s 34. (00:23:12) At the end of the day.
Brian Bell (00:23:13) So basically like a 4x uptake of sessions.
Ryan Eder (00:23:15) Correct. (00:23:16) Correct. (00:23:17) And at the end of the day, (00:23:18) it’s as simple as if you can make care more convenient for patients, (00:23:21) they’re going to do it. (00:23:23) The chances are they’re going to go higher. (00:23:24) If they do it, (00:23:25) chances are they’re going to get better outcomes because they’re actually engaged (00:23:28) in their care. (00:23:28) And then you leverage technology to validate those outcomes. (00:23:31) So there’s no guessing. (00:23:32) So it’s really just yet another example of AI making leverage in our economy where, (00:23:38) you know, (00:23:38) previously I had to, (00:23:39) you know, (00:23:40) get in my car and drive down to the PT office three times a week, (00:23:43) which I didn’t do. (00:23:44) Maybe I went once a week. (00:23:45) And then I’m supposed to do it at home, right, on my own. (00:23:48) Maybe I’m doing that or not doing it. (00:23:50) But now I can click this link, (00:23:52) get this AI feedback, (00:23:53) instant feedback on the exact exercises I should be doing. (00:23:57) And now every PT is, you know, three to four times more efficient in delivering care.
Brian Bell (00:24:02) Because am I still meeting with a PT every week just to check in? (00:24:05) Or is it just like the one and done?
Ryan Eder (00:24:07) You have once a month for the face to face. (00:24:09) We also offer twice a month if you need it, but usually it’s once a month and the rest is done.
Brian Bell (00:24:12) I mean, you’re talking like a X more efficient delivery of care.
Ryan Eder (00:24:17) At least, at least.
Brian Bell (00:24:19) And when you guys go direct to the consumer here, (00:24:23) direct to the patient, (00:24:24) that means, (00:24:25) you know, (00:24:25) your margins go way up compared to a regular PT office.
Ryan Eder (00:24:28) Without a doubt. (00:24:29) Yeah. (00:24:30) Without a doubt. (00:24:31) And to that point, (00:24:32) we have healthy margins, (00:24:33) but we are an entire episode of us from start to finish is typically less than a (00:24:38) single in-person eval. (00:24:39) So we on a blended weighted average are saving 74% in care delivery through this (00:24:45) model without compromising patient outcomes or patient satisfaction.
Brian Bell (00:24:49) So payers love you, right? (00:24:50) So now payers are sending more business your way because you can charge less, right? (00:24:55) For a unit of care.
Ryan Eder (00:24:56) Absolutely. (00:24:58) Materially.
Brian Bell (00:24:59) A higher margin than the traditional PT.
Ryan Eder (00:25:02) Also true. (00:25:03) And while that patient feels more supported, is more engaged, they’re engaged in their care. (00:25:08) That also means you’re preventing more downstream, (00:25:10) higher cost interventions because they are actually engaging in lower cost care up (00:25:15) front. (00:25:15) Right. (00:25:16) And so you’ve got kind of that trifecta of the cost savings, (00:25:19) the high engagement, (00:25:21) the equivalent outcomes through this just by... (00:25:26) you know, supercharging a clinician with AI.
Brian Bell (00:25:28) Are there any kinds of PT that are kind of edge cases that you guys don’t cover? (00:25:33) They just need-
Ryan Eder (00:25:33) Oh, for sure. (00:25:34) Yeah. (00:25:34) Yeah, for sure. (00:25:35) So like, and just even at the highest level, we’re not trying to replace in-person PT. (00:25:40) So there’s a large collection of cases where you can only treat in person. (00:25:45) Right. (00:25:45) There’s also patient preference, (00:25:47) but like the cold reality in the PT industry is a vast majority of patients (00:25:51) prescribed PT. (00:25:51) Don’t go like only 20 to 30% actually go because of these access.
Brian Bell (00:25:56) Yeah. (00:25:57) I’ve had lots of basketball injuries over the years. (00:25:59) So I’ve done, I’m very familiar with PT. (00:26:01) Yeah. (00:26:02) Lots of sprains and ankle sprains and knee sprains and my old grade one tears of my (00:26:07) MCL, (00:26:08) ACL and stuff like that, (00:26:09) meniscus. (00:26:10) So very familiar. (00:26:11) I feel like it was once or twice a week and then they’d give you kind of home exercises to do. (00:26:15) I didn’t have AI watching me and giving me feedback for sure.
Ryan Eder (00:26:17) Right. (00:26:17) Right. (00:26:18) Or even like our patients will say they feel more connected with their PT because (00:26:20) they can message them at any time and get back to them. (00:26:22) Right. (00:26:23) Right. (00:26:23) But like exercise, right. (00:26:25) Like a little recording kind of thing. (00:26:26) And Hey, pain just spiked here. (00:26:27) Can you adjust my care plan? (00:26:29) You know, accordingly, like boom, it’s done. (00:26:31) But to your question also, like the, from a, from a patient standpoint, like,
Brian Bell (00:26:35) Well, another question I had here was like, where does it create leverage? (00:26:39) It sounds like it’s an engagement, you know, personalization, but the tracking and feedback.
Ryan Eder (00:26:46) It gains leverage kind of throughout the whole workflow. (00:26:49) So like, (00:26:51) if you think of the average wait for PT can be three to six weeks or typically one (00:26:56) week. (00:26:57) You make the care more convenient for the patient. (00:26:59) Obviously, there’s the upside there. (00:27:00) They’re engaged. (00:27:01) They get the outcomes. (00:27:01) We measure these outcomes. (00:27:03) The industry actually has a really hard time measuring outcomes in a centralized, (00:27:06) standardized way. (00:27:07) So the payers love it because it’s not only are you getting the economic impact, (00:27:11) but you can give them exactly visibility of what’s going on. (00:27:14) right? (00:27:14) And so just full transparency there. (00:27:16) And so it is really kind of a win-win across the stack, (00:27:19) the challenges scaling in healthcare and a pace at which that, (00:27:23) you know, (00:27:23) the uptake there, (00:27:24) which is what, (00:27:25) you know, (00:27:25) we’re focusing on next, (00:27:27) but the model just works end to end. (00:27:29) And to your question earlier, the, but it’s not appropriate for everybody. (00:27:33) So meaning that like, (00:27:34) we don’t treat patients that, (00:27:36) you know, (00:27:36) have neurological deficits as it’s harder for them to navigate technology into (00:27:40) Independently, (00:27:41) we don’t treat those that have high fall risk because you certainly want someone (00:27:44) there in the event they do fall. (00:27:46) And so always with our partners, we have like an inclusion exclusion criteria list. (00:27:51) So referrals can come in. (00:27:52) Sometimes they have a diagnosis like, hey, we can’t we can’t treat that and defer them back. (00:27:55) There’s so much patient risk here. (00:27:58) 100%, right? (00:27:58) And then even that, sometimes patients will come in, looks good on paper, you do the eval. (00:28:03) This is why it’s so critical to have that first eval with that, like your licensed PT. (00:28:08) And then they make that determination whether or not virtual is appropriate for you. (00:28:11) So we want to make sure that you’re doing as cliche as it is the right care at the (00:28:15) right time and place. (00:28:16) But our whole goal is to capture all those patients that need PT, (00:28:20) but just can’t make the legacy model work.
Brian Bell (00:28:22) How do you think about the size of the market for that?
Ryan Eder (00:28:25) It’s, I mean, it’s, what was it, like 35 million people access PT a year in the U.S.? (00:28:30) I mean, (00:28:30) from a musculoskeletal condition, (00:28:32) one and two adults statistically have, (00:28:34) I mean, (00:28:34) we’ve all got aches and pains to talk about from your basketball injuries, (00:28:37) my back, (00:28:37) my elbow, (00:28:37) my shoulder. (00:28:38) I mean, the older you get, the worse it gets, right? (00:28:40) Right. (00:28:40) So, and, you know, MSK, you know, surgery specifically are one of the top spends in healthcare. (00:28:47) And so the market is massive. (00:28:50) And, (00:28:50) you know, (00:28:50) you’ve got companies that have been in this space delivering digital services for a (00:28:55) while. (00:28:55) Some of them have gone public this past year in 25. (00:28:59) but they have roughly like 1% of the market, which tells you just how big it is. (00:29:05) So there’s a lot of different, (00:29:06) there’s a lot of room for different approaches all in the name of just making more (00:29:10) entry points to access care.
Brian Bell (00:29:13) That’s pretty, pretty amazing. (00:29:14) And you seem to believe that clinician led with AI augmentation wins versus purely (00:29:19) automated models.
Ryan Eder (00:29:20) I’m not, I’m not alone there. (00:29:21) There’s been a lot of studies that have shown, like, I think, you know, (00:29:25) people get overly excited about technology and, (00:29:28) you know, (00:29:29) swing too hard and then end up like saying, (00:29:31) oh, (00:29:31) well, (00:29:32) technology could do everything. (00:29:33) And then they would do these studies and he’s like, (00:29:35) well, (00:29:35) these patients aren’t really engaged in their care when it’s just, (00:29:38) just the tech kind of deal. (00:29:40) So there’s, (00:29:42) In any kind of care delivery, (00:29:43) human recovery, (00:29:44) there’s just a very human element behind it of like, (00:29:47) there’s a comfort level of knowing there’s a licensed clinician human on the other (00:29:52) side that understands your discrete case and is there to help you more than like (00:29:57) putting you in like a generalized playlist bucket of some tech.
Brian Bell (00:30:01) Yeah. (00:30:01) What’s your, so what are your limits to growth here? (00:30:03) Like you need to basically have a PT who’s licensed in each state or can one PT get (00:30:08) licensed in multiple states or some other kind of levers and limits of growth here (00:30:12) for you?
Ryan Eder (00:30:13) From a licensure standpoint, you know, we’re in 45 states right now. (00:30:17) that’s not easy you’re right you have to get licensed in all these different states (00:30:20) different states have different methods some very uh modern some snail mail asking (00:30:27) for documentation from the pts you know previous five employers and their place of (00:30:33) education like so you know there’s that layer to it but that’s all solvable right (00:30:37) we’re almost got all 50 there you then get into (00:30:40) We believe our approach is to be integrated into the existing system. (00:30:44) So there’s a lot of another approach that companies have done is going through like (00:30:49) employers and being part of like their wellness benefits, (00:30:52) if you will. (00:30:52) And I understand that path because you’re not kind of going through the industry (00:30:57) sludge, (00:30:57) right, (00:30:58) to get there. (00:30:58) But if you look at it, (00:31:00) they’re usually spending about 50 cents every dollar on marketing to these (00:31:04) employees and to these members about this benefit you may have. (00:31:08) Humans in the U.S. (00:31:09) access healthcare through their local provider networks, through their PCPs, through their docs. (00:31:14) That’s where they go. (00:31:15) Yeah, (00:31:15) they’re going to go to their family doctor, (00:31:16) and the doctor’s going to say, (00:31:17) yeah, (00:31:18) some PT is warranted here. (00:31:19) Or maybe they send you to a radiologist, and you get an x-ray. (00:31:22) Right, but it’s still your local network, right? (00:31:26) I think it’s statistically over 95% of people. (00:31:29) That’s where they start the entry point. (00:31:30) That’s where I’ve always gone for PT. (00:31:32) I’ve never done the virtual thing. (00:31:33) Me too. (00:31:34) Me too. (00:31:34) So we want to focus there. (00:31:36) So we want to focus where the 95% are. (00:31:38) Now what that means...
Brian Bell (00:31:38) So you got to settle the payers. (00:31:40) That’s your distribution strategy. (00:31:42) It’s kind of convinced the payers here that...
Ryan Eder (00:31:42) It’s a crowd for stack. (00:31:45) So like, (00:31:46) and this is what makes it so hard in healthcare when you want to have it be an (00:31:49) integrated model. (00:31:50) But I think this is the ultimate approach that’s going to win. (00:31:52) So you need to have the payer aligned, but then you’re in the provider network. (00:31:56) We’re getting referrals from PCPs, orthopedic surgeons. (00:31:59) So they need to know about you, be comfortable with you. (00:32:02) And then they present it to the patient. (00:32:03) And that patient, when they’re like, here, you know, we want to prescribe virtual PT. (00:32:08) What the hell is that? (00:32:09) Yeah. (00:32:09) There’s an automatic probably discount in the consumer mind here. (00:32:12) Like, are you trying to like shovel me off to like some software AI thing? (00:32:17) Right. (00:32:17) Like, (00:32:17) are you going to, (00:32:18) like most people think it’s either going to be like pure, (00:32:20) like telehealth visits, (00:32:21) right? (00:32:21) The whole time or like YouTube videos. (00:32:25) and just free for all. (00:32:26) And so like there’s an education that goes across kind of all those. (00:32:29) And then we build up these case studies and (00:32:33) When you can align all that, (00:32:34) that’s when you really start to unlock what this can do, (00:32:37) but that takes time and not everybody, (00:32:39) you know, (00:32:40) has that kind of time.
Brian Bell (00:32:41) Yeah. (00:32:41) It’s a, (00:32:41) it’s a multifaceted problem where you have to sell lots of different constituents (00:32:45) at different layers of healthcare stack all at once. (00:32:48) But it probably creates a little bit of a moat, which was going to be my next question. (00:32:51) It’s like, once you’ve, you’ve penetrated the payer or the provider at the local level, (00:32:55) Now, (00:32:57) you almost pierce the veil and economics drive the decision almost, (00:33:02) especially at the payer level, (00:33:03) right? (00:33:03) Because now payers are saying, nope, go use Lena. (00:33:07) This is way more cost effective.
Ryan Eder (00:33:09) once you’re in, (00:33:10) because our model is so transparent too, (00:33:13) and all the data is available via APIs to send back to any of the payer, (00:33:18) the provider, (00:33:19) you name it, (00:33:19) right? (00:33:20) And we just completely transform it.
Brian Bell (00:33:21) Yeah, any of the EHRs or whatever they are.
Ryan Eder (00:33:22) A hundred percent. (00:33:23) So like, (00:33:24) I mean, (00:33:24) you’re, (00:33:24) you’re, (00:33:25) you’ve woven yourself into the fabric of that provider network, (00:33:28) but then you’re also being able to get fantastic economic and clinical outcomes and (00:33:32) patient satisfaction through this AI enabled.
Brian Bell (00:33:35) Let’s talk about looking forward. (00:33:37) I mean, (00:33:37) you’ve accomplished so much since you pivoted, (00:33:39) you know, (00:33:40) six years ago, (00:33:40) what are you excited about over the next, (00:33:42) you know, (00:33:42) five or 10 years?
Ryan Eder (00:33:43) I mean, (00:33:43) the, (00:33:44) the quest is simply to, (00:33:46) you know, (00:33:47) this is going to take more than just laying up, (00:33:48) but the quest is to invert the, (00:33:51) you know, (00:33:52) ratios of PT adoption, right? (00:33:56) If 20 to 30% are accessing PT now they’re prescribed it, (00:34:00) can tech-enabled care invert that, (00:34:03) right? (00:34:04) And deliver more access. (00:34:05) You know, (00:34:06) Lena alone can’t do that as big as the industry is, (00:34:09) but we want to play our part in that. (00:34:11) And so, (00:34:12) you know, (00:34:12) there’s just, (00:34:13) I’ve met so many patients, (00:34:14) whether it’s post-op or chronic that just have been (00:34:18) living with pain for so long or, (00:34:21) you know, (00:34:21) can’t get to their post-op recovery in the way that they need to, (00:34:24) to maximize it, (00:34:25) that this type of model can help. (00:34:27) So our goal is just to be able to drive awareness, (00:34:30) get integrated into more of these provider networks and provide more access to (00:34:34) patients.
Brian Bell (00:34:34) From a payer perspective, what is the cost reduction to them? (00:34:38) Like what’s your, what’s your pitch to them? (00:34:40) If any of them are listening right now?
Ryan Eder (00:34:42) Well, (00:34:42) I mean, (00:34:42) it’s, (00:34:42) it’s meaningful to where we can, (00:34:44) we’re about a quarter of the cost of traditional PT. (00:34:46) Yeah. (00:34:47) So we are getting significant. (00:34:49) twice the completion rates, four times the engagement rates at a quarter of the cost. (00:34:53) with all very detailed outcomes collection that’s reported back. (00:34:57) I mean, there’s initiatives now happening with CMS that are mandating outcomes collection. (00:35:02) If we’re going to pay this, show me this patient is progressing. (00:35:05) Collect data so I can understand that your treatment, was your treatment really effective? (00:35:10) And so you kind of bundle all that up. (00:35:11) It’s very simple for the payer. (00:35:14) It then becomes, (00:35:14) okay, (00:35:15) how do we integrate you into these provider networks and how to make sure that our (00:35:18) referring networks are comfortable with a virtual offering and get our patients (00:35:22) aware of it.
Brian Bell (00:35:22) When did the technology asymptote, (00:35:24) when, (00:35:25) when did you, (00:35:25) it was like good enough to be widely applicable and widely adopted?
Ryan Eder (00:35:29) I mean, (00:35:29) it was, (00:35:30) it probably took that call it 18 months to 24 months of pushing it through remote (00:35:36) therapeutic monitoring with outside clinicians using it to really hammer it down (00:35:40) and make sure.
Brian Bell (00:35:41) Two years roughly from when you started in 2020 to call it 22, you kind of had it working.
Ryan Eder (00:35:48) Yeah, we had it working good enough.
Brian Bell (00:35:52) when you finally crack that code of being able to run across all these different (00:35:56) devices and having a consistent experience, (00:35:58) right? (00:35:59) That’s where, like, it’s always, you know, it’s always nerve wracking. (00:36:01) We have it. (00:36:01) You start sending out patients where you have no idea what they’re using. (00:36:05) You’re like, all right, is this going to just break on them? (00:36:08) Right. (00:36:08) Because people are holding onto their cell phones longer and longer, (00:36:11) but they’re also getting so much more powerful, (00:36:13) right? (00:36:13) They are, (00:36:14) but you’re also like... (00:36:16) Even if you had a circa 2022 Android, (00:36:18) whatever, (00:36:19) it should run fine.
Ryan Eder (00:36:20) That runs completely fine. (00:36:21) We’ve ran on devices 10 years old. (00:36:23) It runs fine.
Brian Bell (00:36:25) But you also not just have the technology, you just have the technical aptitude of the patient.
Ryan Eder (00:36:31) Like when we were building this, (00:36:33) I thought of my parents because every time they have to download an app, (00:36:37) they’re contacting me about their Apple ID credentials. (00:36:40) Right. (00:36:41) I’m like, well, if you can’t get a patient to download your app in the first place, you’re done. (00:36:45) Right. (00:36:45) Right. (00:36:46) Which is why the SMS to browser works.
Brian Bell (00:36:50) Frictionless. (00:36:51) Right.
Ryan Eder (00:36:53) it takes a UX guy, (00:36:54) a design guy like you to kind of think about the friction points. (00:36:58) Yeah, that’s where the design training just really helped out. (00:37:02) Just thinking like, I mean, all right, you’re going to have all these patients accessing PT. (00:37:06) You can’t just make something that like 30 and under can use. (00:37:10) That’s not going to work, right?
Brian Bell (00:37:12) Well, let’s wrap up with some rapid fire questions. (00:37:15) Rapid-ish fire is what I like to say because sometimes they’re long. (00:37:17) What’s an opinion you have about digital health that most smart people strongly disagree with?
Ryan Eder (00:37:23) Most people think that it’s going to replace clinicians. (00:37:26) It won’t. (00:37:26) I don’t think it will. (00:37:27) I think it’s going to supercharge and expand them but not replace.
Brian Bell Right. (00:37:31) Well, I think that’s the Jevons paradox of all technology, right?
Ryan Eder (00:37:34) Yes.
Brian Bell (00:37:34) It comes in, it makes everything, you know, 5 to 10x more efficient and effective. (00:37:39) And then the paradox is you actually get a bigger demand for physical therapists.
Ryan Eder (00:37:44) Correct.
Brian Bell (00:37:45) Than you had before, because now they’re way more efficient. (00:37:48) And so more physical therapy gets done than ever before. (00:37:50) And we see this in other verticals.
Ryan Eder (00:37:53) Yeah, it happens everywhere. (00:37:54) But there’s always like this fear of change from incumbents that then like try to (00:37:59) protect the past and how things were versus adopting the future, (00:38:03) which usually anytime these new ways of technology come out, (00:38:06) like the future is even better.
Brian Bell (00:38:10) But I understand the fear when it first gets announced and not knowing what it’s going to do. (00:38:14) Yeah, let’s all just go back to living on farms. (00:38:16) Sounds great. (00:38:17) Right. (00:38:19) If you could redesign one part of the US healthcare system from scratch, (00:38:24) what would it be and why?
Ryan Eder (00:38:25) It’s the fee-for-service payment model. (00:38:27) It is unbearably conflicted throughout all the stakeholders. (00:38:33) And so there’s just constant tension. (00:38:35) You see it now where everybody’s so upset about premiums going so high because the (00:38:40) cost of healthcare is going so high and the payers are trying to adjust.
Brian Bell (00:38:43) Didn’t Obamacare, I had somebody else on the podcast talking about (00:38:46) Obamacare actually made it worse because it created this cost plus model where the (00:38:49) only way to increase your profits is to actually increase your costs.
Brian Bell (00:38:53) This happened with utilities in California as well. (00:38:55) We regulated and said, hey, you can’t have more than 10.4% profit margin. (00:38:59) Well, great. (00:38:59) We’ll just double the cost of everything.
Ryan Eder (00:39:02) Exactly. (00:39:03) For every cause, there’s effects, right? (00:39:06) And like every push, there’s a pull. (00:39:08) And I don’t think anyone has like, you know, here’s exactly a model that’s going to work. (00:39:13) We just know what we’re doing is not working and it’s getting worse year over year. (00:39:18) And so, (00:39:19) you know, (00:39:19) there’s some nice initiatives out there that CMS is doing to try to test the (00:39:22) waters, (00:39:22) but nothing happens overnight.
Brian Bell (00:39:24) What’s a common AI and healthcare narrative that you think is dangerously wrong?
Ryan Eder (00:39:28) I mean, it goes back to the one before about AI basically becoming clinicians. (00:39:34) They’re just going to be a tool that clinicians use that is going to make them just (00:39:39) exponentially more efficient and scalable. (00:39:41) But I don’t think you’re going to ever get to the point where you’re purely seeing (00:39:45) like your licensed AI doc.
Brian Bell (00:39:48) I mean, maybe in the really long run. (00:39:50) I’m sure when mechanical plows came out for farms, (00:39:53) they were like, (00:39:54) oh, (00:39:54) man, (00:39:54) it’s going to replace all of us. (00:39:55) And it kind of did, right? (00:39:57) 70% of people used to work on farms, and now it’s like 1% or 2%. (00:40:01) So there will be a reduction of force over the very long run.
Ryan Eder (00:40:05) It’s fair. (00:40:06) It’s fair. (00:40:07) And then I think as society gets comfortable, (00:40:13) with as technology evolves becomes more.
Brian Bell (00:40:15) It’s like self-driving cars, right? (00:40:17) You can go to New Francisco and get a car that drives you around like a Waymo, (00:40:21) but that’s just not everywhere yet.
Ryan Eder (00:40:23) No, it’s not here in Ohio.
Brian Bell (00:40:24) Probably 10 to 20 years for it to fully roll out across the U.S.
Ryan Eder (00:40:27) Yeah, it’s not here in Ohio. (00:40:29) To say like, (00:40:29) oh, (00:40:29) like maybe I won’t get a license because I can just catch a self-driving Tesla or (00:40:33) Waymo for cents on the dollar or to owning a car. (00:40:37) Yeah, (00:40:38) there’s this social and economic kind of drift or drag that happens in (00:40:43) technological rollouts. (00:40:44) It just takes a while.
Brian Bell (00:40:45) So what does ethical AI actually mean when lives, outcomes, and liability are involved?
Ryan Eder (00:40:49) I mean, from my perspective, it’s kind of laced in the question. (00:40:52) It’s like it’s ethical AI is that you’re deploying technology, (00:40:56) but not just solely in the quest of profits, (00:41:00) that you are making sure that you are not compromising care quality patient (00:41:05) outcomes. (00:41:06) right and so you know as long as you keep that true north that we’re trying to take (00:41:11) care of people and not just you know squeeze profits everywhere then i i think you (00:41:16) get there
Brian Bell (00:41:16) we talked a little bit about this but what’s the most underrated or (00:41:20) overrated distribution channel in healthcare that founders should be paying (00:41:23) attention to
Ryan Eder (00:41:23) Attention to i don’t think any of them are the hard part with distribution (00:41:29) healthcare is there isn’t really a single channel i think (00:41:32) The employer channel has been really hyped over the last several years because it’s (00:41:37) been less friction to get in. (00:41:39) But kind of what we talked about before, (00:41:40) it’s like less than 1% of where patients actually access care. (00:41:44) So it was something that could go quicker and you didn’t have to deal with all the (00:41:49) complexities we talked about, (00:41:50) but it’s just not where patients are accessing their care. (00:41:53) So I think that was kind of a little bit over indexed a bit.
Brian Bell (00:41:56) What is the hard truth about patient engagement that VCs and founders don’t want to hear?
Ryan Eder (00:42:00) Well, I mean, without engagement, you don’t have anything across the stack. (00:42:03) I think first it’s the getting to the patient in healthcare is not easy. (00:42:08) And so that alone takes the time. (00:42:10) And so as we talk about that alignment of the payer provider, (00:42:13) then ultimately getting to the patient, (00:42:14) right? (00:42:16) Or if you’re going the employer route and you have to spend all these marketing (00:42:18) dollars to make these patients aware of what’s in their (00:42:21) wellness benefits package, right? (00:42:23) That’s not easy. (00:42:23) But then once you get that patient, (00:42:25) clearly, (00:42:25) if they’re not engaged in your care model, (00:42:28) you’re not going to get the revenue, (00:42:29) the outcomes, (00:42:30) none of it, (00:42:31) right? (00:42:31) So like the, it’s just a, it’s a stack up. (00:42:34) That’s just, it’s what your model depends on, but getting there just takes a lot of time. (00:42:39) And I think I saw where like healthcare change is measured in like 17 years is what (00:42:44) like one study showed. (00:42:45) It’s like that kind of deal, right? (00:42:46) Most startups are like living 12 to 18 months at a time. (00:42:51) And you’re trying to say, okay, I’ve got this funding. (00:42:53) I’m going to show how much I can change here. (00:42:56) But like take even just in our world of physical therapy, (00:42:59) like with the like remote therapeutic monitoring model that dropped in 22 and (00:43:02) everybody, (00:43:03) us included, (00:43:03) we’re super excited about it, (00:43:04) right? (00:43:05) Literally the industry right now, (00:43:06) their bold predictions for 26, (00:43:08) four years later is that this will be the year of RTM. (00:43:11) And so like four years gone by to where they think this will be the year they start (00:43:16) adopting that model. (00:43:17) It’s just painfully slow. (00:43:18) Again, the futures here, it’s just not equally distributed, right? (00:43:21) It just takes time to make people change and realize things are better. (00:43:24) On average, (00:43:25) I see roughly 10 years, (00:43:28) 10 to 15 years, (00:43:29) you think about the capabilities of mobile phones. (00:43:33) They’re pretty much here in 2010, but it took until 2020, 2025 for it to be widely distributed. (00:43:41) Everybody has it. (00:43:42) Useful for everyone. (00:43:45) Your grandma’s using it. (00:43:48) And I’d make an argument that COVID actually accelerated that timeline.
Brian Bell (00:43:51) Right. (00:43:52) I had like a, like a regular flip phone until recently. (00:43:55) Right. (00:43:55) Yeah. (00:43:56) Sure. (00:43:57) Non-smartphone. (00:43:58) Right. (00:43:58) Yeah. (00:43:58) I mean, four or five years ago.
Ryan Eder (00:44:00) Yeah, (00:44:02) in a twisted way, (00:44:03) for us, (00:44:05) it was like what made this model doable is that COVID forced everybody to learn how (00:44:10) to do video visits and on to where you had this global event that raised the (00:44:16) technical aptitude of an entire population to some degree, (00:44:19) right?
Brian Bell (00:44:21) I was in Silicon Valley and people were remote back in 2014. (00:44:24) That was very unusual and unique. (00:44:29) In 2024, pretty normal, right?
Brian Bell (00:44:32) Pretty normalized, right?
Ryan Eder (00:44:33) Absolutely.
Brian Bell (00:44:34) If you had to bet on a major shift in care delivery over the next five years, what would it be?
Ryan Eder (00:44:39) just care outside of the, just in general. (00:44:41) It’s just care. (00:44:42) The technology is just going to let people access care when they don’t have to go
Brian Bell (00:44:46) to the- Eventually your phone will be like a tricorder from Star Trek and you know, (00:44:50) you just like self scan yourself and the doctor will be like, (00:44:53) yeah, (00:44:53) okay. (00:44:55) They’ve got these ones like biometric companies that are able to pull a lot of vitals. (00:44:59) Yeah, (00:44:59) your temperature, (00:45:00) your pupils dilated, (00:45:02) the degree of sweat, (00:45:05) skin temperature, (00:45:06) all that stuff. (00:45:07) What does building and healthcare tell you about resilience that you didn’t learn (00:45:10) in design or your earlier life experiences?
Ryan Eder (00:45:13) I mean, based on my journey, it’s everything sticking around. (00:45:16) This is, this is year 20 technically of this journey, right? (00:45:19) Stemming from my thesis and without resilience, that doesn’t happen. (00:45:23) And so it’s not everybody signs up for that. (00:45:27) I didn’t know I was signing up for that and getting into it, of course. (00:45:30) Right. (00:45:31) But, (00:45:31) When you’re in healthcare, (00:45:33) like the rate of change coupled with the rate of change of an administration that (00:45:37) impacts what healthcare looks like to every election cycle as well. (00:45:41) Like there’s just a lot of variables there and being able to navigate those and (00:45:47) stay alive if you go through it is critical.
Brian Bell (00:45:50) What’s a habit or operating principle that you use consistently that keeps you (00:45:54) grounded as a founder?
Ryan Eder (00:45:54) I just try to shut up and listen as much as I can. (00:45:57) I think a lot of people, (00:45:59) a lot of founders, (00:46:00) entrepreneurs like to shout from the rooftops and like, (00:46:03) I know the future. (00:46:05) Here’s what it is. (00:46:06) I like to take a different approach of just understanding where people are and try (00:46:10) to connect the dots and then deliver something to help guide them. (00:46:13) But to do that, just listening, being empathetic and keep building.
Brian Bell (00:46:18) Awesome. (00:46:18) Last question. (00:46:19) What advice would you give to a founder building in healthcare today who feels like (00:46:22) the system is too slow to change?
Ryan Eder (00:46:25) If you’re looking for a quick turn to make a buck and parlay it to your next (00:46:30) adventure, (00:46:31) don’t go to healthcare. (00:46:32) Just don’t do it, right? (00:46:33) Build a chat GPT wrapper for coding or something like that. (00:46:37) Right. (00:46:38) You just don’t do healthcare. (00:46:39) Now, most people in healthcare aren’t looking to do that. (00:46:42) They’re there because the impact they can make, of course, right? (00:46:45) So I think, you know, you go to all these, you know, (00:46:49) the health conference by all different conferences you’re going to hear the same (00:46:52) narrative every year because it takes so long for things to change but you also (00:46:55) hear everyone is there because they just have a passion for impacting people’s (00:46:58) lives and that usually while everybody wants it to go faster that’s that’s the fuel (00:47:03) to their fire
Brian Bell (00:47:03) Love it. Ryan thanks so much for spending an hour with us i (00:47:06) learned a ton about this I’m walking around a lot more knowledgeable about the (00:47:10) space I really appreciate it
Ryan Eder (00:47:10) No thanks for having me. I appreciate it, thank you.
