Video Transcription
David Kuraguntla 00:01
Dave. I'm Dave Kuraguntla, co-founder of Alio, and we certainly believe that health care delivery is about to change rapidly. And for far too long, we've been stuck with devices that are really aimed at the healthy. Well, they get the basics. It's nice to see some of the new things that are going on out there and actually going after the FDA clearances. But still, if you want to get the real data that's typically found somewhere in the ICU, right where lots of wires and blood draws are, and if we really want to move this to the hospital at home, we're not getting the right data at the right time. We're not able to actually treat those patients and be proactive. And you need something that has clinical accuracy. It's real-time and it's actionable, and that allows us to actually potentially reduce the total cost of care. So where do we start? Well, my co-founder and I, last time around, were very much a hammer looking for a nail. It was great. We got acquired by a strategic partner, which allowed us to self-fund this company for the first couple of years. But what we really focused on this time around was starting off with the customer experience and where the patient need was. And we found that in the kidney disease space, it's an oft-ignored market by both founders and investors. You're an exception. But other than that, it's been ignored for a long time, and a big part of that has been around the fact that where's the need, where's the cost, and a big part of that cost is actually in the hospitalizations and the complications. And there's now some nice tailwinds as well, because a lot of this is now value-based care, at least in the US. So you've got millions of patients worldwide. It's a very rapidly growing market, and there's a need to actually tackle this. So we'll think about this from the perspective of the patient, first and foremost. And I think here, as you go along that entire journey through those early stages of kidney disease, that decline in kidney function, and ultimately to the end where most of these folks are on some form of either kidney replacement or on dialysis, there are very common complications. We know what they're going to be. There's three of them, and they're going to cause about 80% of your hospitalizations for the patient population; everybody knows they're there. So worldwide, we've mandated the need to do blood draws once or twice a month. We've told folks they've got to go get some sort of an imaging study. But as you might imagine, from the patients' perspective, it's invasive, it's disruptive, and it's certainly not sufficient, and ultimately, they feel demoralized and like everything is out of their control. From the clinician perspective, they realize that the exact same things are true. We know the key problems. We know that we have to tackle it, but they effectively have a sampling error problem. And the key feedback that we heard when we first started talking to them was all of these issues are preventable if we just have the right data at the right time, but it's a lot of different pieces of data that they need today. It comes across multiple different visits, different techniques, different diagnostic tools, and none of that exists all in the same place, of course, up until now, and from the clinician perspective, it just feels like they're flying blind. Now, I mentioned the payer side. On the payer side worldwide, we're seeing this change, whether it's in the US, there's a massive shift towards value-based care. We're even seeing that here, where you've got a single-payer system, or newer countries that are kind of growing and realizing, wow, this is our biggest drain on our medical budget. How do we actually tackle this problem? How do we provide, quite frankly, both a carrot and a stick for keeping these patients out of the hospital? I'll focus on the US, just because it's a little bit more simple. But from the perspective of where this was up until a year ago, a couple of years ago, sorry, there was a clear fee-for-service world. But now that change has happened very rapidly, where it's gone from less than 10% in value-based care to almost two-thirds of that market. Once again, if we look at those key complications and where they're spending their cost, it's not actually on delivering care. It's actually just spent, once again, on purely these preventable hospitalizations. That's 50% of where the cost is spent, but that amounts in real dollars to about $45,000 per patient per year. And so the ideal solution for this is something that's fully automated, is remote, and can get the right data at the right time and be comfortable for the patient. And that's where Alio comes into play. We're capable of doing all of that. It certainly starts off with a wearable that's worn by the patient. It's completely non-invasive. There's no needles or anything else that's collecting that data passively throughout the day and pushing that forward, certainly enabling the alignment of what we like to call the four Ps: the patient, the physician, the provider, and the payer, meeting all their needs the best way possible. From the patient perspective, they can go about their lives; it's as simple as wearing a band-aid. Go do what you want to do, go for a swim. It doesn't matter to us. You're going to go live your life automatically. That data is going to be collected. It's pushed up to the cloud. We run our series of proprietary algorithms on that, and what's nice is that that's where we also leverage our AI model to not only look at the data that we've ingested but the historical data as well. That's allowed us to push past our initial set of metrics into new ones that we're going to talk about today as well. From the clinician side, what we made sure of in our clearance, from a clearance perspective, is it's not just data for data's sake. Two things that were in our favor are that we were able to get clearances for actually letting the clinicians know when patients were outside of the bounds of normal. And the nice part as well on the clinical side is that there's already a series of international guidelines around where to maintain these patients. Therefore, there are already thresholds defined, and there are already clinical workflows defined for if it's too high or if it's too low. And what that means is we didn't have to come up with the thresholds; we didn't have to come up with the clinical workflows. We could just focus on solving this sampling error problem. So once again, after a few different FDA clearances in the US, a Saudi FDA clearance earlier this year, and we're expecting CE mark here in the next couple of months as well, we're able to not just bring the basics that you might expect of things like heart rate and temperature, but also bring in things that really move the needle for this patient population. So being able to get hemoglobin and hematocrit more accurately than even Massimo can, comparable to your blood draw. The same is true when we became the world's first company capable of getting potassium completely non-invasively. We then had two more software updates this year focused on looking at that access dysfunction, making sure that there's actually flow there. We added on fluid status as well. And then really excited to be able to not just have that on the SKD population, but on the CKD population. Now, at large, we've already seen a great amount of off-label utilization of that. So now we said we have to go expand the label, which we are as well. And then also excited to bring blood pressure to market. What's different for us than others is that we're true systolic over diastolic. There are a lot of companies out there that talk about having blood pressure, but one, typically requires calibration, which we don't. Two, it's not actual systolic over diastolic, which we are. And three, we're able to deploy that on the same hardware that we already have out there, and you still have the clinical accuracy that's comparable to an A-line. And all of these things tackle very, very large comorbidities and costs that are multi-billion dollar issues each on their own, all in the convenience of a single device. So once again, being able to tackle a $45,000 a year problem at the end of the day, making sure that's easy for the patients is important. And the feedback that we've already gotten from some of our early commercialization and our soft launch is, "This is really easy for me to use and to wear; I get the right data that I need at the right time." And for the clinicians, they appreciate the support that our team is offering as well. Just with one customer and a six-month review, they came back and said, "Hey guys, you already saved $800,000 for our employers over just a handful of patients that we put it on with them." And other customers are really excited; they have a large home program, and for them, they're used to their nurses having to drive out to their patient homes, and now they're just calling them up and saying, "Take an extra pill today." It's completely reduced their workload and changed the way that they're done, and they feel like they're actually supported and able to do their jobs, which I think is really important for those folks that are not in some sort of value-based program. The nice part is that there is reimbursement for this as well, so you can still get reimbursed. You can still approach the clinicians. And additionally, we're excited that just a couple of weeks ago, we got our first coverage by a Medicare plan as well, so being able to shift into the value-based care world. Being able to showcase that ROI to those early adopters has certainly been important. So fundamentally, there's an end-to-end platform now for one of the most expensive patient populations out there in the world, in a way that keeps them out of the hospital. But we think there's a lot more going from here. I mentioned moving this beyond just kidney disease to others as well. And the nice part is that we focus on that chronic disease space where a lot of folks want to be by focusing on very much an enterprise sale. So we have lower customer acquisition costs and much longer lifetime value. So instead of a seven or 14-day feed kind of repayment cycle, it's typically over multiple years with rolling contracts, which is nice and pretty short cash cycles. Because we're on a capitated budget, we're getting paid up front, rather than struggling through a risk-based contract. Fundamentally, lots of clearances that keep adding on, compounding each year off the same hardware. Really strong pipeline in terms of our customers; as I think we submitted this a month ago, it's already out of date. There are two more contracts added on to that, and a really awesome runway for growth and a real, clear path beyond profitability. We're not raising right now, but excited to be able to start doing that again early next year. But we will be announcing two strategic partnerships over the course of the next two months that we're very excited to do. So fundamentally, we're really excited about Alio getting very close to being able to scale faster than we even possibly imagined, and beyond the initial place that we thought, in the kidney space, into the adjacencies that people are already utilizing in places like heart failure, oncology, and others. Thanks again for your time. Please feel free to reach out to me at Dave@alio.ai, and I'll answer any questions you might have. You.
