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: Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I really thank you for tuning in and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have an outstanding individual and leader in healthcare. His name is David Weingard. He is the CEO at Fit4D. Their goal is to solve for diabetes medication adherence in a very unique way. And David's got a really unique background with the technology and sales background. Spent some time at Microsoft then went over to start his own company as part of the startup health moonshot to help the diabetes solutions. He's done some really great and innovative things that fit Fordie. So what I want to do is just open up the microphone to David so he could fill in any of the gaps and then we'll get into the diabetes discussion. So David welcome to the podcast my friend.
: My pleasure. So great to be here.
: Hey it's a pleasure to have you. And so what is it that got you involved in the health care, David?
: So I got into health care because one day I went to my doctor and I had absolutely no energy stepped on the scale of 159 on a good day and I was 129 and I lost 30 pounds in three weeks. And the doctor told me I had type 1 diabetes. So my life changed at that moment. And I was completely overwhelmed. I've been an athlete my whole life been a runner. I had already done nine man track funm. No diabetes in my family. So I needed help. And the doctor was able to prescribe medication for me, insulin and given a point with his nurse the next day to learn how to take it. But I really needed somebody to help me through and educate me. I looked online a lot of good information out there wasn't personalized to me, went to the local hospitals and the next diabetes training classes were two months away. Wow. And I needed help now. And I was fortunate to meet a great diabetes educator a lady named Cecilia who took the time to personalize all that content online and make it meaningful to me. Give me the support, the compassion and really help me get to an empowered place in my life. And that really changed everything for me it was a magical experience. And from that I decided to dedicate my mission to improve the health of people with diabetes and leverage what I learned through Cecilia.
: That's amazing. David. What an amazing story. And you know I could feel the confusion, the frustration and in come Cecilia and she just lights the path for you which is amazing right. And not everybody has a Cecilia and so it's interesting that that you were able to locate her and she was able to provide that insight for you. What do you think today is missing from the health system? What's a hot topic that needs to be on every medical leader's agenda?
: Well when you look at the providers and ask them what's the number one thing they want to accomplish with their patients they say we want them to follow our care plan and take the medication and the number one thing they don't have time to follow up on is exactly that. So how do we deliver a value based service that makes it easier for the provider to deliver outcomes for their patients and to get them back into their office to take care of them. And so when you look at diabetes specifically this 30 million people in the United States with diabetes about 5 percent of them have type 1 like myself. Body doesn't create insulin anymore. Type 1 is also called juvenile diabetes. And the other 95 percent of Type 2 people with diabetes which is more what you hear about in the media about type 2. And you know when you look at the numbers and getting connecting those people with Cecilia's, there's maybe 30000 of them in the U.S. the only way to do that is with technology to scale Cecilia's so they could virtually meet the needs of the population. People are busy. They take care of their families their careers. How are they going to take the time off to get to a diabetes educator and how are they going to do all the work in a way that fits into their life? And so I think that's a huge issue is about fitting into people's lives making sure that they follow the care plan that the doctor prescribes and actually delivering measurable outcomes.
: Yeah for sure, David. So on this topic give us an example of how you and your organization have created results by doing things differently.
: So it's interesting if we take for example two different patients one is a mom who's taking care of her kids. You can't take care for diabetes till the evening something so simple as having diabetes educator on the phone or communicate through technology like e-mail and text when the kids are in bed is a way of fitting into the person's life you know rather than trying to figure out how to do it during the day or traveling to a doctor's office. The virtual component is really key. The other part is really personalizing to what the person needs the most. May have a patient that was diagnosed a specific diabetes medication and the side effect is nausea in the first 30 days. We can't really talk to them about improving their diet until you help them with what they're stuck on because they don't want to hear about it. They might not even take the medication or drop off because they're dealing with that nausea. So getting them through that issue and then moving to the things that you can try behavior change so the level of personalization making it meaningful. You know another example is someone who walks out of a doctor's office overwhelmed with a sense of failure maybe their grandfather passed away from diabetes. So again you have to have compassion and support and help them through that experience before you're going to help them learn how to take the medication. Do the behavior change that's critical to take care of the diabetes. Meeting people at where they are. It's one of the biggest lessons we've learnt.
: So totally love the outline that you just provided, David. How do you guys meet people where they are? How do you do that?
: So one of the things that are diabetes educators do me they focus on building trust with the patient and it's always the same. Diabetes educator that works with the patient. So if we're calling on behalf of a health plan we are saying you know what I got your back. Basically your personalized diabetes educator for the next X months. And people really resonate with that. They're not used to that level of service from their health plan or provider. They appreciate it because the patients are motivated to change. You just don't know how to do it. They don't either have the education or the time or they need somebody there to keep them accountable. And so what we make sure our educators do is they build a trusted relationship first solve for what the patient is stuck on and then start moving them through the diabetes journey. And that's an art. I mean it's taken us eight years of innovation and testing in the real world with big pharmaceutical clients, medical device clients, health plans. How do we do this in a way that not only creates trust but is scalable. There's a lot you can pay clinicians ten different ways if they are with 10 different patients. How do you do in a way that is scalable drives return on investment for the clients the is measurable outcomes. That's the art and that's really what we spent most of the time on during our innovation years.
: That's fascinating. Now listeners David and his team are doing some outstanding things. They recently made an announcement of an expansion with Humana to deliver personalized diabetes coaching in South Florida. David you want to dive into a little bit of that and kind of give the folks some insight into what you guys are doing over there?
: Sure. So if you look at Florida as an example one out of every four people in Florida have diabetes.
: One out of every four. Is that right?
: Yeah. It's a large part of it is that there's such a large senior population and type 2 diabetes usually progresses as people get older. But we really these people are overwhelmed and even if they can visit the doctor and they have the mobility to do so and the support system they really need somebody that's going to get to know them and motivate them and help them through the questions and their stocks around some of the things we've talked about so far the medication. How do I change my diet? How do I integrate exercise at my age? There's so much education that needs to be done. So Humana recognized that there was a need. The providers were completely overwhelmed to our earlier point of you know the number of diabetes patients and how did they get them educated and on a healthier direction without spending hours that they don't have per patient of their own. And so Humana stepped up to deliver this service to for their benefit to lower costs and improve quality measures and for their members benefit for that to improve their health. And so we're really the provider that's delivering the service. And it's a win for the physicians it's a win for the patients and it's a win for Humana.
: That's amazing. So just want to say congratulations to you guys on that partnership but also the bigger picture you know helping this population that is that is struggling and that is Unnur served in a really big way. So it's a big kudos to you and your team, David.
: Thank you. We're making a difference every day and it's one of our core values is the passion we have for members and it's really incredible to see how lives can be changed.
: Let's zoom into that a little bit more. Maybe this example or maybe another example that you guys have changed lives. Can you tell us a little bit about how you guys have improved outcomes?
: Absolutely. So this a clinical measure called A1C which is the average blood sugar level over three months and that is from Medicare it's a triple weighted quality measure in the commercial population it's a key measure that the commercial population uses to measure the likelihood of diabetes complications. People don't die from diabetes they die from or have complications because of related things like heart a heart attack or a neuropathy where they lose feeling in the nerves and the fingers or in the feet. And so A1C is a key measure to see how diabetes health is progressing over aid is considered poorly controlled. So we'll work with health plan or watch provider group to take their patients that are poorly controlled and work to do the behaviour change to get them on the medications and get that agency measure down in one population we work with. We were told that the patients were all on an oral diabetes med and when our diabetes educators got to work we found out they were prescribed mealtime insulin as well which you know gets into a lot of medical science here but basically a mealtime insulin covers the food that you're eating. So when you eat carbs you need insulin to cover those carbs so you're enjoying the meal. And these patients didn't want to take the injection they didn't know why it was important and just want to stick with the pill. And by getting these patients to recognise the importance of taking the insulin we were able to change the A1C measure and deliver quality measures lower costs and get the patients healthier.
: Amazing. What a success story and something as simple as finally looking through what was going on. Identifying the problem and just communicating it being that that heart and that voice to be present during that care scenario at the home. So I really appreciate you diving into these very personal and impactful moments that you guys have been a part of David. In your mind to date it hasn't always been smooth, what would you say a setback that you guys experienced as you guys developed the company and what did you learn from it has made you guys stronger?
: Well I think when I go back to eight years ago the health care landscape especially for innovation wasn't as mature or resilient as it is today. So we went to look for funding and we were basically told unless we were a million multimillion dollar business we wouldn't be able to raise money and it was true. So we went out and we delivered results by signing real paying clients where we innovated while we got paid and we were all we showed that we were results based and were able to innovate while we engaged in the market. Nowadays you can kind of get a startup amount of capital to begin testing but frankly I'm glad we did it this way because by the time we finished our art of signing multiple clients and growing up business, we had real data in the real world as opposed to just small pilots here and there.
: That's amazing. So you really were just forced into signing your clients and delivering value ASAP and that was character forming.
: It was great and it built the cultural business one of our five core values as being results based, on being results based for our clients delivering return on investment and quality. Another one is compassion for our patients so these really develop during these years and getting things done.
: Love it. Hey have you ever read shoedog?
: I Haven't.
: You haven't I think about that because it just kind of resonates. You know those guys. Phil Knight and his team. Man, they were struggling they winning they couldn't get money from any banks and that was one and their one of their tough spots and with much grit and focus and vision just like you guys have that Fit4D. Much to your credit they were able to persevere and now look at them. So I think it's so awesome. Appreciate you sharing that story with us and listeners. The takeaway here is don't lose sight of your regime. Keep working at it and get those results. The money will follow. David you say one of your proudest medical leadership experiences to date is?
: We have a system in our company where we share with our clients the best call the week. And I wouldn't say there's one particular call but it's the process of capturing those magic moments and sharing the wins with our health plan clients where we have patients who are literally crying on the phone for help and how they'll then subsequent calls saying how we change their lives. And those are the kind of things that we've learned to capture and share and treasure. And then it's you know simply things like understanding culture and language. We have now not only life in English but in Spanish and Chinese. And to understand.
: You know if you're going to guide people to even within a Spanish culture speaking culture to a taco it should be a Mexican Spanish speaking person as opposed to what we deal with here in New York which is mostly Dominican Spanish so the patients really appreciate that their clinician understands them understands their socio economic background and it's not just reading from a script. They're really authentic and really trying to help them in a very personal way.
: Amazing. I love that David. And definitely something to be proud of. And you know I love that you mention that you know systematizing these magic moments rather than just experiencing them like let's let's find a way to capture them. And that's really thoughtful because being in the trenches it's easy to lose track. And so where did the inspiration to start documenting these and saving them come up from.
: It actually came up from one of our clients they said you know we'd love to hear it. And this goes back maybe four years ago and said that's great let's do it. And we started realizing the power of both at a client level and also internally.
: I think that's so great something that we can all take a note from. Tell us a little bit about an exciting project or focus that you're working on today, David.
: So we continually enhancing our platform to be able to scale our clinicians and one of the things that we're being asked for is not only to help with diabetes but comorbidity as well. So a lot of the same patients who were dealing with diabetes were also dealing with cardiovascular disease. And so there's a slice of the population that we can help at a much deeper level and so continue to innovate. There is a big focus when you look at a health plan that's 18 percent of patients account for 40 percent of the costs. And for us to be able to focus on that 18 percent which is really the hardest part of the existing care management programs that sees management may help someone out there may help the core population. But the chief medical officers are really struggling with the people who are poorly controlled and an 18 percent. And so branching out with diabetes and cardiovascular as exciting new opportunity for us.
: That's awesome man. And with the success you guys have had in the core offering I'm sure that will definitely be another area of high impact. So excited to keep up with the things that you guys do and and really look forward to hearing more about that. David let's pretend you and I are building a medical leadership course and what it takes to be successful in diabetes and in medicine. It's the ABCs of David and so I'd like to write out a syllabus with you today. I've got four questions, lightning round style followed by a book that you recommend to the listeners. You ready?
: What's the best way to improve healthcare outcomes.
: Human touch, trust, leveraging technology. After building trust by the human being.
: What's the biggest mistake or pitfall to avoid?
: To rely on apps or web sites to change behavior.
: Love that one. How do you stay relevant as an organization despite constant change?
: Teamwork and communication and learning every day.
: What's one area of focus that should drive everything in your organization?
: Patient care. The outcomes of the patient drives everything.
: And what book would you recommend to the listeners as part of the syllabus?
: One of my favorite books is a book called Blueprint to a Billion. It's especially would be dear to anyone who's an entrepreneur or a business minded talks about getting marquee customers about building your board of directors. And it has a lot of data from the most successful companies about how they got to this spot that they are so highly recommended.
: An amazing shared thank you for that. Definitely going to have the added to my list, David. And listeners don't worry about writing any of this down. I know David's provided so much value in this episode. Just go to outcomesrocket.health/fit4D and you'll be able to find all the show notes links to fit for DS website as well as a transcript of all the things that we talked about and links to the book. So David before we conclude, I love if you could just share a closing thought and the best place where the listeners can get a hold of you.
: You know this has been great and health care is in such a state of transformation now and the pace of innovation is accelerating. That we're excited to be part of it and I encourage everybody to engage as a transform and be open minded to what's what's possible fit4d.com is our website. We also have a Linkedin community called Diabetes Innovation and a Facebook community. Love you to engage and if we can help you let us know.
: Outstanding and David they could get a hold of those communities through your website. fit4d?
: Yes www.fit4d.com.
: Outstanding David just want to say thank you again for spending time with us and we're excited with the stuff that you guys are doing to make the lives of people with diabetes better. Keep doing what you're doing man. The ripple effect is huge and we thank you for spending time with us today.
: Thank you very much.
Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.
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