Episode 31: Working with Ronnie Screwvala and Scaling Healthcare : Abhishek Shah of Wellthy Therapeutics: Scaling a Healthcare Startup in India with Technology
Scaling a Healthcare Startup in India with Technology

Working with Ronnie Screwvala and Scaling Healthcare

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Origins of Medicine in Indian Civilization

Before we understand the story behind scaling a Healthcare Startup in India with Technology, let us understand a bit more about the origins of healthcare in Indian Civilization.

Unlike most other countries, healthcare in India has its origins in myths, mythology, and tradition. In fact, like other ancient civilizations, Indian Mythology has a god for medicine – Dhanvantari. In the Puranas, he is the god of Ayurveda. He is the god that rose during the churning of the ocean of milk with the nectar of immortality.

Lord Dhanvantari
Lord Dhanvantari

Indian Contributions to Medicine

India has given to the World, Ayurveda, an alternative medicine system. Ayurvedic texts categorize and identify herbs, vegetables, and fruits into those beneficial to a certain bodily disposition. This has found its way into daily Indian cooking thru various healthy recipes and concoctions.

Listen to another entrepreneur changing Healthcare in India: Amit Munjal of Doctor Insta: Season 1, Episode 9

Indian Ayurvedic dietary supplement called Chyawanprash / chyavanaprasha is a cooked mixture of sugar, honey, ghee, Indian Gooseberry (amla), jam, sesame oil, berries, herbs and various spices
Indian Ayurvedic dietary supplement called Chyawanprash / chyavanaprasha is a cooked mixture of sugar, honey, ghee, Indian Gooseberry (amla), jam, sesame oil, berries, herbs and various spices

The Father of Modern Plastic Surgery is from India

There are significant contributions to modern healthcare from the West. However, it would surprise many of us that the father of Modern Plastic Surgery is in fact from India – Shushruta. Shushruta’s book on Medicine is important to World medical literature.

Image Showing Ancient Indians Treating Patients
Contribution to Indian Medicine

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Scaling by Changing Behaviors and Beliefs

Given India’s significant contribution to healthcare and the various age old recipes and beliefs, treating modern lifestyle type diseases becomes a challenge. Lifestyle diseases such as Diabetes, Heart Ailments become tougher to treat as care does not match lifestyle choices. Most care procedures originate in the west and make it difficult to adapt to Indian lifestyle choices.

This is the social background for Scaling a Healthcare Startup in India with Technology.

Origins of Wellthy Therapeutics

Abhishek Shah of Wellthy had an interesting upbringing. He was an engineer and had a scientific bent of mind. His parents were successful entrepreneurs. However, Abhishek saw that existing care was not catching up with their lifestyles.

Working with Ronnie Screwvala and investing in startups gave him an outside-in perspective on ventures. How did he combine the two to build and put Wellthy Therapeutics on the path to scale? How did he succeed in Scaling a Healthcare Startup in India with Technology? That story is here:

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Here are some excerpts from the Episode:

I think we set out to solve a problem in a very different way, I guess. It was a first principle approach to be able to solve for healthcare, I was fortunate to see how very interesting technology enabled companies had built themselves out over the last two years before I started Wellthy.

[01:55] Abhishek

So, let’s dig into that outcome term a little bit. What was the trigger? It is one thing to see a bunch of people, you know, build tech around health and come from a healthcare background, but there must have been some sort of a trigger, what was the trigger? And do a deep dive on the outcomes that you’re referring to. 

[03:42] Krishna

Both my parents are alpha males and alpha females. They are both individual first-generation healthcare entrepreneurs, they run health care businesses themselves, and therefore getting anything across to them and making them change their habits is a miracle.

[07:36] Abhishek

I’ve asked myself the same question. I think it was much younger than that. I don’t think it was as mature a I thought, it was a problem that I felt was worth solving.

[18:24] Abhishek

It’s so fascinating, the role that the environment sometimes you unwittingly discover the environment you grew up in unwittingly ends up helping, right?

[22:52] Krishna

So, first things first, we didn’t start as an app, we started as a study on WhatsApp. And I think that was very transformative for us because even before we went and built out an entire product suite, it was first really important to check that independent of the user interface, does the science work?

[26:35] Abhishek

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Word Cloud for Episode 31: Working with Ronnie Screwvala and Scaling Healthcare : Abhishek Shah of Wellthy Therapeutics: Scaling a Healthcare Startup in India with Technology
Word Cloud For This Episode

Abhishek Shah on Twitter here: @abhinshah

Maharajas of Scale on Twitter here: @maharajaofscale

Follow Krishna Jonnakadla on Twitter here: @kjonnakadla

Episode Transcript

(Automated Transcript)

SUMMARY KEYWORDS

patient, outcomes, healthcare, health outcomes, solve, physician, build, entrepreneur, journey, therapeutics, problem, diabetes, drive, condition, life, fortunate, working, people, carnatic music, whatsapp

SPEAKERS

Abhishek, Krishna Jonnakadla, Tania Jadhav

Krishna Jonnakadla  00:01

This is Maharajas of Scale, a podcast where we go behind the scenes and talk to founders who are demolishing the myths around building and scaling a big business in India. These are the stories that have shattered the assumptions around Indian consumers and changing the game completely. I am Krishna Jonnakadla, serial entrepreneur, co founder of FLIT the fashion located in town and startup mentor, bringing you these stories. Hey listeners, fabulous cloudy Thursday afternoon in Bangalore, you know the COVID pandemic is still wreaking havoc in the country. But amidst all of this, we are talking to an interesting entrepreneur of a company called Wellthy led by Abhishek. You know, the funny thing is technology helps us in many different ways and for a country and several cultures that stubbornly refuse to change their behavior. abishek has done wonders with his startup in changing and helping people lead a healthy life, Abhishek, welcome to the show.

Abhishek  00:59

Thank you. Krishna for having me. And it's a pleasure to be on the show.

Krishna Jonnakadla  01:03

Awesome. So abishek tell us a little bit about yourself and what are you working on right now?

Abhishek  01:07

Sure. My name is Abbie shake, the co founder and CEO of a company called Wellthy therapeutics, we're on a mission to inspire and enable millions of patients or, you know, users to help improve their health outcomes. And just having a really rough over time trying to make that happen through a very, very complex health ecosystem. So that's, I guess, by day by. Outside of that I'm a father of two incredible children and live in Mumbai, and I guess, like everyone Cabin Fever after a few months of the pandemic, so teaching to itching to get out into the real worlds. So tell us a little more what have you managed to do it? Well, the so far, so um, well managed to get it out of a concept stage and in To into something that's really helping members improve their health outcomes. And I'll backtrack here. And I think we set out to solve a problem in a very different way. I guess. We, it was a first principle approach to be able to solve for healthcare. I was fortunate to see how very interesting technology enabled companies have built themselves out over the last few years before I started, where are we and in that journey, you know, I come from a healthcare background. And I was very clear that if I wanted to solve a problem, I wanted to solve it in a first principle way, which is improve health outcomes and then unlock economic value in the process. Right, and that was, that meant going down a different route than traditional sort of a traditional startup. We spent three years in clinical r&d and pilots and studies trying to improve health outcomes in our first condition that we were solving for which at that point was tight. to diabetes. And since that time, you know, really have been working with life insurers, health insurers, large health systems, pharma companies and medical device companies to be able to drive improvement in health outcomes across multiple conditions. So today we're fortunate to be working with several of those partners, working in multiple conditions in in a couple of countries, and driving health outcomes today across what more than 500=600. And I'm fortunate to be able to not just build a business but also really impact the lives of of people.

Krishna Jonnakadla  03:42

So let's dig in to that outcome. term a little bit. What was the trigger? It is one thing to see a bunch of people, you know, build tech around health and come from a healthcare background, but there must have been some sort of a trigger, what was the trigger and do a deep dive on the outcome outcome that you are referring to?

Abhishek  04:00

Sure you always find a personal story somewhere in in most of most founders out there, right? So for me it was that I come from a family of healthcare entrepreneurs, and therefore saw, you know, how how much there was a need to be able to drive better health care, both in India as well as globally and all, as with everything, you know, my parents were diabetic, pre diabetic and cardiovascular between the two of them, and really saw how you know how pills and Doctor consults and diagnostics can only get you some of the way that but unless and until you are able to stitch it all together to you know, have continual care, you know, you if you have a lifelong disease, you don't want to solve a lifelong disease with going to a doctor once every year or once every six months. You need to do more and more importantly, it needs to fit in your life and not the other way around. So looked at their pain points and figured that there has to be a way to solve it with goes beyond the pill to be able to make real outcomes happen. And then went back to you know, as I mentioned, first principles I'm, I'm a geek at heart so went into clinical studies, clinical trials, read a whole bunch of information, you know, the those PubMed and sci fi and and all these other tools were my, my best friend for a few months, as I investigated the clinical efficacy, if you will, or, you know, the fact that what I'm what I'm talking about is actually doable on the ground and a lot of data to prove that at work, but obviously nothing in India at that point in time. I said, Okay, you know, let's get into this. And, you know, initially inspired by patient zero sitting at home, but then I guess the the wheelbarrow started started moving, and the snowball effect came with every success story that we're able to help out, even in the initial days when we were just doing studies. Right. So yeah, I mean, that that ended up being the trigger. Obviously, it was it was it was what triggered The entry into it and and a lot has happened most.

Krishna Jonnakadla  06:04

Interesting. So work with me here we'll do a little more of a deep dive that is pretty fascinating. With patient zero your parents being at home and thinking the thought process in your mind at that point in time was my parents have are either pre diabetic or diabetic. And the way care and all care related processes are structured right now is it is mostly treating the symptom all the time. And also not even the psychosomatic or the you know, mental health of the patient. Because Indian physicians are so overloaded. They barely have time to even look at the disease and treat it. The last thing they're going to do is offer therapy. So why is it that hey, there is another side to it, and there is a behavioral side to it. And therefore, instead of being in this forever maintenance mode, where there's just popping pills and doing a few things, I need to change what happening to them. So what did you set out? What did you see broken? It is one thing that yes, you know, especially if it is a lifelong disease, there is something that you have to do but there are also the outcomes in a lifelong afflicted disease is even more tough, right? Because the assumption is that okay, all you need to do is you know, take these pills go through the go through the motions, so that it doesn't get out of hand. So what did you set out to change that it achieves a certain degree of well being to the patient? And if it's well being what exactly?

Abhishek  07:36

No a lot to unpack over there, but maybe some description on the parents I wish they were What do you say they are my both my parents are alpha males and alpha females. They are both individual first generation healthcare entrepreneurs, they run the health care businesses themselves, and therefore getting anything across to them is that easy, and making them to change their habits is is is a is a miracle, but principally sort of the way the problem the way I saw it was that, you know, they're moving from half a pill a day to one pill a day to two pills a day to three pills a day. And you know, really healthcare is not able to adjust to their way of life, right? And it's not it's not just behavior, it goes beyond behavior. If I don't want to prick myself to check my blood sugar, then well, how else do you have a feedback mechanism that's working whether or not you know you're moving the right direction or not. If I am a an entrepreneur, then I am more greeted than the average Joe. But that doesn't mean that my mental health issues don't need to be solved for if I need to make sure that I conquer my health, I have to ensure that I build these tiny habits into my existing routine, so that I am able to keep control of my health versus my health sort of just go on a spiral because I'm I have other priorities in life. So for me, it was a fascinating subject where I looked at the health outcome that the pill is supposed to give. So let's say you know the sign Can we say there is a pill, that pill has been approved by the regulator or by the FDA, because it is supposed to drive a improvement in outcomes by, say, five units. But that five units is in a clinical trial setting where it's a perfect patient, it's a perfect health care systems a perfect protocol, leading to a near perfect outcome on the back of which there is a clinical approval given. But when that is actually given to, you know, patient x, that, that five units doesn't is not even two units, right? And it's not just because of the pill, right? There's a lot more than than the pill that you need to do to be able to drive better outcomes. So when I looked at that, and I said, Hold on, if you even need the, the outcomes for existing standard of care to be good, then you have to hand ensure a lot of the things around that happen. You have you are fortunate to have like a 45 minute consult with a doctor when you're in a in a in a in a regulated healthcare environment. Er you know, mushkil say you in five minutes or 10 minutes is what you Get and that too is, is because of a very, very stretched healthcare system where a physician barely has time to view you doesn't personalize any treatment to you beyond the point, and just gives you what sort of they can do in the period of time that they have available to them. So it was just that a multitude of things I said, we said that I need to solve for this because if this is not getting solved for my parents, who are easily some of the most fortunate people in India, touchwood, who have great access to health care who are intellectually well rounded in terms of what is required on health care, we have great physicians around them who have greater access to medicine around them. And even they can't get their outcomes in order. And a lot of it is not to do with them. It's to do with the ecosystem around them. Then what will be the state of affairs, you know, for other people who are in this country, and there's a lot more that we can do and digital can step up to the challenge and make that happen. And I was fortunate to live in a world or an ad prior to that because I was investing in early stage businesses. I saw The power of how consumer tech can transform behavior. And that behavior change was being seen in e commerce in so many other things back in the day, and I felt that if that can happen in in in all of these areas, why can't we bring it to healthcare and that was where I think the penny dropped from.

Krishna Jonnakadla  11:17

Very interesting. Many investors would actually say, anything that requires anything that is going to be behavior changing, is almost like a fool's errand. You know, there is this dichotomy, which says, You should build habit building products. And the other end of the spectrum says, if you're going to build something that is going to change somebody's behavior, you know, good luck with that, so to speak. And here it looks like you got completely excited about making that happen. So dig in a little more. So that was the initial hypothesis. And then what were the initial beginnings, like, how did you think so? At this point in time, I'm thinking diabetes just was one And then your eventual thought was, Hey, I let me pick up a disease and work around it. And then you know, I'll start seeing evidence on that. And I could apply to you also need different contexts, different populations, that sort of stuff. Right. So talk a talk about that initial beginnings. What was the product? Like? How did you put it together?

Abhishek  12:19

Yeah, sure. So I when I started, so the parts of it that really gave me a lot of confidence was science had shown studies, clinical trials, a lot of data globally had shown that it's not binary, say you are able to improve somebody is, you know, skills to manage a condition by 20%, then there is a 20% improvement in outcomes, right. So it's not like somebody who's not walking, the traditional way of sort of handling that situation would be the physician would say, guidelines meccanica had 30 minutes a day. You should be walking 30 minutes a day. But, you know, the fact is that people need help right to be able to get the 30 minutes a day. It's not about like, just because you tell me When I have never walked a minute in my life and you tell me to go 30 minutes a day, how does that make any sense and what clinical studies have shown that even if you get them from zero minutes to 10 minutes a day, there's still an improvement in health outcomes that can be seen, I'm using activity as a very crude example. But it sort of works sort of across the board, right? That it's not binary, where it's not zero or one there is an in between. So that was really encouraging. And the other part was really encouraging was, you know, these habit forming tools that have already sort of come into our lives using technology, you know, if they can do it, you know, in health care, you can do it too. Now, it's isolated, there is by no means you know, that the problem has been solved. There's a long, long way to go. But that every Delta improvement is is is really meaningful. So as we, as we went through that journey, we went through it in an iterative manner. We didn't go through it trying to say, build perfection. On day one, it was step wise, it took its own time, which is why, you know, we spent three years in in pre revenue Before we even went commercial, because we saw that it's not just about improvement in health outcomes, it is also about safely doing, and doing it in a manner in which you hold yourself accountable to the same high standards of care, that that medical devices and pharma holds themselves accountable to, because that's the only way to do it. You can't just go out and put anything out there. So we Yes, we started in diabetes. Uh, honestly, the when I started the journey, the choice was either diabetes or cardiovascular conditions, because by parents and both, and I wanted to solve for them, but then there were some choices that we made, which ended up working out well, right, for example, diabetes is just better is a mathematical equation. So there are very accurate, you know, point and point of care devices like you know, the finger prick blood sugar monitor that people have at their homes. There is another test call an HB one, see which user can do everyone in three months. And there was a whole bunch of other Teams which me the engineer was like, you know, what if I have to solve one of these two brothers all for diabetes first because at least there are checkpoints to know, you know, whether you're moving in the right direction, not just us as a company, but also the individual when they're going through their journey, but the intent was always to do more. So started with diabetes expanded into a lot of other conditions now, but very, very fortunate, very thankful that we got to go along this path.

Krishna Jonnakadla  15:27

Very interesting. We'll come back to the start with diabetes and do a little bit of a deep dive on that one. But I keep hearing you talk about business and entrepreneurship and technology so entrepreneurship ran in the family, but what what was your background like what was what did you grow up wanting to become and then what did you do before starting wealthy wealthy is or is it how we say it? Well, you therapure exam, belly belly therapeutics,

Abhishek  15:58

Yeah, a lot of people pronounce As well as high therapeutics, if anyone works, but my journey I mean, I grew up in a household with entrepreneurs and they I wouldn't say at random my blood, but I did, I would say that I got a taste of it sort of early on, and therefore was always fascinated by it. I spent a few years working in the businesses, went to B school came back, I decided that I want to get exposure outside worked with an incredible entrepreneur in the media and entertainment business, Ronnie screwvala, who and I was fortunate to not just be part of the journey that led to the UTV exit, but also, you know, was part of the venture team, where we started investing in early stage businesses. So I had an incredible run but as all fine family dynamics co you know, being a somebody who was high up the food chain in, in investing in early stage businesses, still, as far as my family was concerned was a job. Like as an entrepreneur or two entrepreneurs in the family, I'm a black sheep if I'm if I'm taking a job, so you know that that's really powerful, right as a as a motivator to be able to find a problem to solve. And there was that way I was very fortunate to have a family that was very encouraging of, of getting out of a comfort zone and actually going out and trying to solve a problem and figuring out something that I was passionate about. So spent a year as an entrepreneur in residence in another fund are, you know, trying to figure out the problem or to solve all roads for me led back to health care, but this time at the intersection of healthcare and technology, and just, you know, this just intrinsically made sense. And I felt that I could spend the rest of my life trying to figure out a solution to this problem and really, you know, give back but at the same time, you know, really create value in the process.

Krishna Jonnakadla  17:50

Interesting. So, so in some sense, you had some kind of vague idea that you are going to be an entrepreneur, but you went out there Just to get a sense of what, what it was like in the other part of the startup world, although you had seen your parents run businesses, what was happening around how our deals made? And then eventually would you say the beginning choosing? Well, the with a start where you focus on diabetics? It was, did it ever look like it was an outcome of all the thoughts you had been having? All the while?

Abhishek  18:23

I've asked myself the same question. I think it was. It was much younger than that. I think I don't think it was as mature as I thought it was. It was a problem that I felt was worth solving. The company kind of got built around the problem. It didn't. It wasn't like a culmination of everything that I was doing. I didn't add, I don't think I knew I was going to be an entrepreneur. In fact, if there was one thing I knew, I thought I would be a, you know, a second generation entrepreneur where I would be working with the family but honestly, that's not the same as starting your own business. I can tell you that with the with absolute confidence, you know, that it's not It's a very different path. But I definitely knew I wanted to give it a try. But I didn't want to do it for a problem that I did not think was worth solving. So for me, a large part of that journey was identifying a problem that I fell in love with. And then, you know, building a company around that. That's where I'd say that, you know, the lion's share of time on the Discovery went everything else sort of follow through after that.

Krishna Jonnakadla  19:24

 Awesome. So let's dig into that three years. I would say research phase a bit. Three years is is a really long time. At least. That's what the media would have you believe. Right? You know, and I see repeat this ad nauseum when Walmart got listed on the New York Stock Exchange and Sam Walton and his family together became millionaires or billionaires overnight. A reporter or someone asked him, oh, you're an overnight success story. And Sam Walton replied saying I was an overnight success. Only 20 years in the Making, right but in in this case, he was doing what he allowed and I know you were doing what you loud as well, but spending three years that must not have been easy. And in that three years, there should have been some sort of a methodology I'm sure where you are saying, okay, we are doing this we are doing this we are doing this check. So what we talk about that part a little bit,

Abhishek  20:22

So two sets to it, right? Yes, there was a methodology. And they were very dark patches as well in between, right, I wouldn't say for the company, but personally, it's always hard. So, you know, from being you know, you know, somebody who is I'm naturally an extrovert person always sort of out there. You know, spending time with friends, family, whatever. When you start your own venture, it's, it's it's hard, emotionally and, and, and mentally, right. And it takes a lot to be able to do this and to be able to couple that with everyone having high expectations of you because they should know their loved ones around But to be able to know that the path that you're taking is slow and steady and really slow versus what, you know, traditional startup, you know, people would put would entail. That is, that's a journey that, you know, it tests you as an entrepreneur, I would say, for me it was. The reason why I went down that path is because that's the only way I knew how to build a healthcare business. From a first principles perspective. You don't go out and go direct to consumers, you first do your studies, you first validate that what you do works, you build an evidence pathway, you make sure that you do not compromise the safety and security of patients you are able to show to physicians that what you do actually works, you publish that data in, in publications, you present that data you you hear critical feedback, you improve, you iterate, all of those things which were hard baked in my head because of the The good fortune of having healthcare entrepreneurs sort of in the family were things that, you know, were in my head as I as we as we went down that path. But that path doesn't come, you know, it wasn't as sort of planned as you would call it was planned from the perspective of we knew that we would be revenue positive only after the first three years but there is a there is a you know, an emotional side of things that that every entrepreneur needs to know where it's hard. It's you know, when when everyone has these expectations and you have to have a smile on your on your face when you are sort of out there at parties and events and whatever have you right, it's but as long as you deep down have that commitment, you know that this is a problem worth solving. You have a plan to be able to go out and fix it, you know, you weather through all of that. But it's it's something that, you know, it's a hard lesson.

Krishna Jonnakadla  22:51

 It's fascinating, the role that the environment sometimes you unwittingly discover the environment. Grew up in unwittingly ends up helping right so here you had parents they were working in the they had benches in the healthcare space. And you didn't have to reason out because take a quick detour, I'ma carnatic music student and for carnatic music. In the 15th century, there is a carnatic music, the father of modern carnatic music called curandera dasa. And what he has done is, he has established a series of exercises. So, from the very basic notes, all the way to the advanced songs, he wrote out exercises that people could take, and then start discovering what carnatic music was all about. And then, because I've had the good fortune of comparing two different worlds, when I look at, you know, the world of startups today, I see that there is no such begin here. And then you go here, and if you do this, if you get this outcome For every thing that you need to do, there's, it seems like there are 10 different, or maybe 50 different ways to do it, depending upon who you hear that from. But in your case, I think unwittingly, would you say, seeing your parents do it, and the fact that if you had to build something in healthcare, you could follow these steps. And if you focused on this, that would give you some assured outcomes. Revenue possibly is attached to those outcomes. So that in some way unwittingly helped you they sort of had this map?

Abhishek  24:33

They didn't have the map, I think the map was, was more, you know, on the belief that if you are able to improve health outcomes for patients and you're able to do that reproducibly there is a path to create value, what that value is, I didn't know nobody knew, at least I didn't know when I started, right? Right. But it was that belief that then as long as you're making impact and you're able to, you know, you know, have a third party, even value validate and you're able to replicate this, then intrinsically in healthcare there are, you know, there is a way to be able to, to to create value. So, the, the one of the reasons we also began as is with studies was that, you know, it may have also been that all of this didn't work. And as a result of which we are not able to show the outcomes. And if that had been the case, there may have been, it could have been that we, we did not pursue this and we pursued something else. So, it also serves as a as an initial MVP, if you will, then it's always good to do that, right. And however, low tech and however quickly, you can make sure that your MVP is out the door to validate what you do. And you run quick experiments and you continue to maintain that culture. However, how you scale as an organization, that's always going to be beneficial for you.

Krishna Jonnakadla  25:53

Interesting, so let's dig into that diabetes angle A bit. So if you could take the diabetes Example and walk us through it. We've talked about the behavioral changes. For instance, let's say 30 minutes of exercise or being able to eat what's important, according to that. So as you started working through diabetes, what did you start uncovering? What sort of outcomes do you start seeing? So then you had built an app, in this case. And in that case, the app had a series of cues or series of measurements, talk about the that initial version of the app. What sort of early success Did you see that gave you the feeling that yes, we are onto something?

Abhishek  26:34

So first things first, we didn't start as an app. We started as as a study on WhatsApp. And I think that was very transformative for us because even before we went in, built out an entire product suite, it was first really important to check that independent of the user interface is does the science work? So I'm that's why I'm a healthcare guy, right. So before solving for anything else, Solving for the technology I wanted to solve for the science and and check that if you are able to deliver this in a completely digital zero, you know voice, you know, no physical touch points way are you able to actually meaningfully improve health outcomes and not just from the way the patient or the user says but also validated from the treating physician, also validated from a third party, you know, diagnostic or lab test that that can validate that there is not just an improvement in outcomes on a daily basis or on a week basis, but over a period of time, there's a sustained improvement in outcomes. And that sustained improvement in outcomes continues even beyond sort of the time period that the that the user or the patient is is working with, because that's what science said is possible. And then we went out and first wanted to validate that so that's what we did you know, the from the time the company was formed through the time that we actually got the first product, you know, out the door, I think there was it's hazy in my timeframe, but I think it must have been even a year before we got a actual product, which was which was, you know, built as an application. Because to be honest, there was so much that you can do without, you know, actually investing so much time in trying to build out something which is which can be at least tested in the environment with existing tools that are there. And that's what we did. And that for us was transformational before even the product came because by the time we got the product out the door, it wasn't about whether this worked or not. It was about how do you make it better, right but the whether they worked or not moment didn't come through tech that we created in the front end was tools that we created with the back end but using an interface that was already well known. Very interesting. So talk about that a little more. This is this is fascinating. So what exactly did you did you put out there on WhatsApp, and you know what, what sort of stuff Did you do that so We went into guidelines, you know, now that I guess the healthcare geeks came out in in full form, where we went into massive 500 page guidelines of how treatment should be delivered as far as standards of care when globally, so and then looked into that and reimagined how that treatment protocol would be, if it's not episodic care, which is the way in which all of the guidelines in the world today are written, they're not written as there is a patient, the patient is living with a condition, let's say ask them or diabetes or hypertension, and therefore what should be happening every day, what nudges, what touchpoints, what behavior changes, what skills, what habits, what adherence, none of that is written, everything is written along the lines of when the person comes into your chamber. This is what you need to be doing over the 40 minutes. And then this is how you need to be doing a follow up right. So reimagining that into delivery of care continually, that was where sort of a lion's share of our time went, right. So we spent a disproportionate time not on the, on the tech early on, but on the on the protocols on the care protocols on the on the entire healthcare delivery. And that really worked for us, because we went into the minutiae of things. And we ended up, you know, holding that as a very core principle of our company, which is go very, very deep into the condition and make sure that you're able to work within those existing standards of care. So for any condition today that we're operating in, we, you know, the same formula is is is done, obviously, we do it in a lot more depth. But yeah, that's that's sort of the way in which we approached it, right. So it was science or health care, first, delivery of care second, and then driving, their engagement, that retention, the net promoter score, and the comes that come in. And there for me lent that principle of, you know, invest in the process, not on the outcomes. Make sure that your process is clinically proven to drive outcomes, but then focus on the process because the outcomes will follow.

Krishna Jonnakadla  31:17

 So in this case, the actual user, I'm just trying to unpack that initial WhatsApp, let's say, the outing I would call it the maybe pre MVP or even the MVP you had formed, let's say groups, or maybe one on one. So was it was it the end patients that were on WhatsApp or visitor caregivers?

Abhishek  31:38

 It was the end patients that was on the WhatsApp it was it was one to one n patients on WhatsApp and then an incredible amount of user research that that went with that right so I can't explain to you how important it is to to invest in whichever business you're in right investing in understanding each and every one of your stakeholders. In my case, it was treating physician Family members of patients patients themselves paramedical. And, and and understanding their day in the life of understanding the pains, the opportunities, the the instances and then going in not from a solution mindset, but from a problem mindset. And then from that sort of iterating and picking through which pieces of the puzzle that you can solve for. So for us, it was one to one, it was a, we did it as a as a specific time frame protocol, where we were driving a specific primary and secondary outcome. We held ourselves accountable for it, we measured, we had a baseline measurement at the beginning, we had a baseline measurement at the end, those measurements were done both by us or not by us by the patients, as well as by a third party independent authority. And then, you know, we published that and then this data is actually out there for anyone to see. Because we were fascinated with the results as well and it it blew our minds that you know it because it went well beyond clinical outcomes, I think that was a eye opening moment, it wasn't just about the improvement in outcomes which for measured from a clinical perspective, which a physician would be happy. But when you see the empowerment that comes to a user, the confidence, the, you know, the end user stories and feedback, you know, we had so many testimonials where they were crying and giving feedback, you know, on, on how this has changed their lives. And it touched us far more than the Delta improvement mathematically, because we realized then that there is more to unpack than just a in number in a clinical file of a patient, there is far more that healthcare can do. And we're going to set out the rest of our lives and trying to solve that problem.

Krishna Jonnakadla  33:46

So at the cost of diving too deep. Let's say in this case, you had one on one with diabetic diabetes patients who had a certain reading of the sugar levels. So looking at all the options diffic you know, the literature that you had poured through the studies, the research papers. So you know, the way I'm understanding this is, okay, your sugar levels are x, you're a type two diabetes patient, which means this is going to be a chronic disease. And these are some of the things to be done in order to address this condition. And the WhatsApp sessions at that point in time, the interactions where was it like some sort of a caregiver, following up on them saying, okay, have you done this? Have you been able to do it? Is there something stopping you, Sam? I'm thinking this is where the therapeutic therapy part of the well the therapeutics name comes in. whereby if you are saying, okay, you have to exercise 30 minutes today, for instance, you're saying, Okay, is there something that prevented you from getting exercise and then you're saying, okay, you need to do it, and I'm possibly oversimplifying it, but at the end of it as a result of all of this, you did it with, I don't know how many patients, you took it all together. And this is what you do. And versus what a traditional, you know, a physician would have done which is, you know, checked on them maybe once in three months or six months while they visited, or if it is a patient that required insulin, they just came for insulin shots. All the physician did was he went through the motions. And he said, okay, have you done this? Have you done this, but on this hand, you were there very closely to assist. And therefore, not only did the sugar levels stay far below, or maybe way, will manage, but they will also see themselves be energetic, and they were able to put in that 30 minutes of exercise. They felt so good about themselves. I am painting some sort of an approximate picture of what you were able to accomplish in that experiment?

Abhishek  35:46

 Yeah, I think you've actually painted it really well. Maybe to add a couple of things right. It was at the core about building tiny habits. So it was about building tiny skills to manage your condition better So it wasn't about it was more being a companion than being an advisor. And that's honestly something that is lacking in, in in multiple chronic conditions. Because patients go through serious difficulties every day, right? It's a you're mentally, you know, you're seeing somebody eat something and you know, you can't eat it or it's gonna affect your body in a very different way. You know, say if somebody was not walking, I'll just give you an example. You can't get that person to, to to go 30 minutes. Like I'll give you an analogy, if it's the way I see the world, right? If it's through the lens of a treating physician, what do they do say a patient walks through their door, they consult them, they give them these incredible, like, let's say the patient and the and the physician are both standing at the edge of a beach and the fire to paint a picture. The physician tells the patient that this if you do this, this and this, then you see that island over there which is in the middle of the ocean. That's the island of paradise. That's the island of Like you know what after your weight loss after your activity after your medication adherence after your, you know, checking your blood sugar and after you just managing your health ready well, that island is where all the golden jewels and treasure sits. And he and the, you know, the the physician gives the binoculars to the patient, the patient sees the island, the island looks so really close. And then they say, Okay, I can do this and they, they get on, you know, the boat, they start rowing. And inevitably 99 out of 100 patients midway through the rowing give up and you see a carcass of of patients who all know that they need to get to that island and every physician in in their truest heart wants the patient to get there. But they're unable to roll all the way there because it's just so far and therefore you know, the way we see the world. The problem is not that the island is wrong. The problem is not that the goal is wrong. The problem is with the binoculars because if you talk to About a goal that's so far away, that's so hard to achieve for a patient, you're never going to be able to actually get every single one of them there. versus if you change the perspective, and you say it's not about something that say 42 kilometers away, but it is something that is 500 meters away, and Okay, you've achieved the five meters, okay, let's get to the next 500 meter goal and so on and so forth. The tiny tiny pieces are far more achievable than, you know, the then then a full blown marathon, right? And that's the way we see the world and that's the way we have constructed a lot of what we do today as well.

Krishna Jonnakadla  38:34

Very, very, very fascinating. So in some sense, it is that map and the series of tactics, it is equivalent of that tiny lessons that I referred to some time ago about carnatic music. So okay, and now I'm, you know, I'm really, really fascinated a lot more now. I now I have a hang of this. So talk to talk to us about the initial results. And then now I think is the right time to jump into this Scale journey. And at what point of time did it occur to you that briefly if you could say, Hey, we have got something here. And then you took all of this information from WhatsApp and converted it because of obviously, you know, technology, if it's used well can be a panacea. Talk about that part and the scale journey.

Abhishek  39:19

Sure for these were these are a multitude of data points that we didn't run one study, we actually ran several, I can't remember exactly what the count is. But I think it was more than 10 or 12 publications that we had, because it wasn't just about one cohort, we had to, you know, do it across multiple, we had to do it across different personas. We did it across different stakeholders. So you know, getting whether it's with working with clinicians, or working with a combination medical device or working with a drug or working with a life insurer or a health insurer. I think we we needed to sort of do it across several cohorts to to know that it was working and of course the product evolved and over bit of time, we were doing a lot more. And that gave us that confidence, the outcomes. You know, from a technical perspective, there was an HB one C, which is that three month blood sugar fasting test or not fasting three month blood sugar average test, which we were able to show improvement and outcomes significantly higher than the unexpected, we were able to see a massive uptake in user confidence in user satisfaction, in adherence to therapy in follow up in confidence of the person managing the condition better checking in with the doctor and understand and getting that feedback that physicians were really happy with the way in which the treatment was progressing and the way in which their patients were behaving, and a whole bunch of other parameters, right, weight loss, obviously, diet, medication adherence. So it's not one metric. There are several that that we were able to sort of over a period of time monitor, improve and improve at scale. And that gave us the confidence that that were Getting to something that can be commercialized because that that basic first principle of healthcare just takes us back to the fact that if it's not safe, and you are not able to show that you're clinically validated and clinically relevant, then you should not be, you know, treating patients. So, we went out and, you know, first got that, you know, those studies published we got, we got the seal of approval that came from the relevant, you know, associations that hey, what you guys are doing actually makes sense, and this works. And then we started scaling, you know, and we still today work with with, with a lot of enterprise partners. So for us, it's still that pharma med device, life insurance, health insurers, large healthcare systems, where we're driving or pushing the envelope to be able to drive better health outcomes. And that's something that we just see us doing more and more often. We're we're fortunate enough today to starting from one city and work With a few clinicians and a few patients to now, you know, operating in over 600 cities and towns working in, in working outside of India as well. fortunate to work with, with with really incredible large partners, who are what we're looking into this go beyond beyond diabetes, of course, where it cardiovascular conditions were in respiratory conditions. And the team is now you know, more than 100 people. And we're really, really excited about the journey ahead because it's more of the same, right. And that's the most exciting part. It's not about doing, you know, dramatically new things. We see an incredible opportunity and incredible gap in the market, to be able to to scale this and that's what we're all about. And as a result of our initial, I guess, foundation of being focused on outcomes and focused on the patient and focused on the journey and not the end goal. We were fortunate to To have to build and put together a team, which is as passionate about solving the problem, you know, so not obsessed about the solution but obsessed about the problem. And everything that goes with right. So and and a large quantum of team members have family members who are suffering from a condition themselves. So, you know, motivated on solving the problem at a personal level. And that's what keeps us going. Because at the end of the day, yes, there is value creation to be unlocked. But you have to have fun and a higher purpose in doing it right. And, and we strive to do that more and more.

Krishna Jonnakadla  43:36

 Terrific. So in terms of patients, how many would you have affected ever since you got started?

Abhishek  43:42

So we keep that information private for a whole bunch of reasons, but it's less than 100,000 at this point. So we still very, very early in our journey, but we are hardcore enterprise focused where we are where we are driving health outcomes with enterprise partners. So it's all b2b to see if you will We don't have a direct to consumer sort of channel yet.

Krishna Jonnakadla  44:03

Oh, that's still a big number of people who, to whom I think you've given, I suppose, in some sense, I don't want to use the term best stored, but help them reach a better life situation with what they are going through. Right. So that is fabulous. So I know we are short on time. But if you were to look back, let me back up a little bit. You know, it's fascinating. In healthcare, it has always been established that you could take cohorts like for instance, every drug, that new drug that's out there has these stage one, stage two, phase one, phase two, phase three clinical trials, right. And they are established, there are established protocols to do that. funny when you look at it in the startup world, they say, Sam altman of Y Combinator for instances, just speak of hundred users first and make them really super happy. I know it's not a directly analog is situation but somewhat similar. So looks like you did that. And if I had to possibly give a good metaphor you took James, what James clear talks about in atomic habits, you took atomic habits and created a some site, some sort of a support plan for all these patients. This is fabulous. So looking back anything you would change anything that you would do differently?

Abhishek  45:23

I would scale quicker when I mentioned the you know, there was that that journey? You know, it's not, it takes an emotional toll on you. So I would definitely scale quicker if I could, I would. Oh, my God, I don't think there's a founder who tell you that there is nothing that they would do differently. I will there's so many small, small things that I think today, the focus I have on on the internal culture that we're building within the organization. If I could tell my you know, my, my younger version of myself that, you know, I would I would tell him to do Prioritize five other things and make sure that you focus on culture and value systems and, and you know, and that in the company, you know, very, very early on, I would, you know, build a lot more focus very early on because when you're small, you're also chasing many, many things and many, many opportunities. Versus today, I can say that, from the outside in, it may look like we're looking, we're doing a lot more but from the inside out, I can tell you that we're doing a lot lesser things just a lot more deeply. So focus, I would say culture, you know, and, and getting your early team members banged on, right. I think those are things that dramatically changed the destiny of any company. So I would definitely go back and change some of those things to be able to but I wouldn't change a thing about the problem we're solving and how we're solving it that I'm that I'm that I'm super excited and continue to be confident.

Krishna Jonnakadla  46:55

Awesome. In some sense. You answered my next question, in terms of what would be your two cents on advice to other entrepreneurs who have already started up or who are considering starting up about some things that they should keep in mind. This is been a fabulous discussion, appreciate for, you know, those entrepreneurs, when I listen to a podcast, I usually have a pen and paper handy and I'm actually waiting for that moment. I'm thinking, Okay, this happened. This is how I placed it. This is something that they did and I'm writing taking notes. I think the wise ones will understand what you did, and I think it's awesome what you've done. And to our listeners out there, guys, this I'm sure this is going to be helpful. We read all reviews and all comments and respond to them. And we thank Abhishek for being on the show. And we wish Valley therapeutics you know, grow even more. I think they have something going affecting millions of lives positively. And when you've achieved another, scaled some more Abhishek, we will be back to talk to you to see what vantage point looks like.

Abhishek  48:01

Absolutely thanks for having me over and a pleasure and and looking forward.

Tania Jadhav  48:06

We hope you enjoyed the story. If this story made a difference to you, tell us by leaving a comment on the website, or our social media channels. Help us Spread the Love by subscribing, liking and sharing the show. We welcome speaker suggestions and collaboration. Write to me at heythere@maharajasofscale.com