OR_Sempre Health_Chris O’Brien: Audio automatically transcribed by Sonix

OR_Sempre Health_Chris O’Brien: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Rich Prest:
Hello everyone, and welcome to the Sempre Health Outcomes Rocket podcast, where we talk with healthcare leaders on the state of the industry, patient engagement, and technology innovation. I’m your host, Rich Prest, and today, we’re fortunate to be speaking with Chris O’Brien, who’s the CEO of AdhereTech, which is one of the early leaders in the smart bottle approach to adherence. Chris has had a long career as both an entrepreneur and investor, so I’m sure you’ll have plenty to share with the audience today. Chris, welcome to the podcast.

Chris O’Brien:
Thank you, it’s great to be here.

Rich Prest:
Definitely, excited to have you on board. Maybe just to get started, you can help share our listeners. Maybe, did you have a dream career when you were growing up, and maybe what was your path to where you are today? Yeah.

Chris O’Brien:
I did have a dream career when I was growing up. I wanted to be a physician and in particular an emergency physician. And I realized later it was simply because all of my skiing accidents and everything else, I’d be spending a lot of time in the ER. Chainsaw accidents, so that’s kind of doctor I saw most other than my mother, who was a pediatrician. But yeah, but yes, that was not to be, although I ended up in healthcare in the end anyway.

Rich Prest:
Yeah, so what was your path to, you took to where you are today?

Chris O’Brien:
Well, you know, I started my career as a software developer a long time ago, actually, at Bell Labs, when there still was such a thing. And I ended up coming up there and very quickly moved into startups. I worked for a macintosh software company actually in college. And then after school, I just started my first company despite a complete lack of skills and experience and the knowledge to do that, but that’s the way the young are and it ended up not dying but took seven years instead of the two or three it should have taken to get where it needed to get, but worked out in the end.

Rich Prest:
Oh, that’s awesome. Yeah, kudos to you for having the courage to do that. So it’s very cool. And then when you look back over your career, is there an accomplishment that you’re perhaps most proud of or you want to share? Yeah.

Chris O’Brien:
I guess I’ve been part of some really amazing teams and had the privilege of building some of those teams. And I think for me it’s as much about the people that you work with and the impact you have on the world. And yes, we’ve all had business successes, and sold my last company to Hewlett Packard, which was quite an experience, let me tell you, it took a long time and that was great. But it’s you know, I think really the, you know, the work that we’re doing here at AdhereTech and prior to this, I was at a company called Everyday Health, helping to deliver continuing medical education to physicians and educate physicians on the latest news and therapies. And I just feel like for me, in this phase of my career, there’s so much that needs to change in healthcare in the United States and around the world, and so many incredible therapies that are being developed and yet physicians aren’t prescribing them, or they are prescribing them and patients aren’t taking them, that, there’s a lot of really basic things we have to get right. And I’m just really pleased to have found a perch at a place like AdhereTech where we can have such direct impact on patients’ lives.

Rich Prest:
Very cool, and so looking forward in terms of, if there was something you wanted to be remembered for in the industry, is it some part of fixing this crazy messed up system that we have or?

Chris O’Brien:
It is, yeah, and you know, I think Sierra Coop, the former surgeon general who was …., when I was a kid, had a famous saying, which is that drugs don’t work in people that don’t take them. And you know, it’s such a tragedy because we live at a time when there’s been so much progress in drug development and different ways of treating serious conditions, things like cancer that used to be just the C-word and that’s it, your life’s over. And now it sometimes is the case still, sadly, but a lot of times, if you can manage to take your meds and stay on therapy, you can live many, many decades afterwards and a very happy life. And yet far more than 50% of patients nonetheless fail to take those meds and end up going into the hospital or worse. It’s quite a human tragedy.

Rich Prest:
It really is, yeah, I think it’s a lot of what motivates us at some point as well. I think we may use the same Cooper quote because I think it is so helpful in terms of just framing the basic problem. And, you know, I always think of it as sort of the last model problem, right? We’ve gone to all the trouble to get the drug approved, to get the doctor to write the script, and yet so much of that just doesn’t end up actually with the patients who need it.

Chris O’Brien:
That’s exactly right, and it’s just a very sad thing. You know, people get diagnosed this serious condition, they spend 8 minutes with the doctor, hopefully, get handed off to a nurse educator and learn a little bit more about it, and then they’re sent home and left to manage their condition on their own. And just, it’s very, very difficult, even for those of us who are relatively healthy to remember to take your pills on time, to remember to follow up with your doctor, and with the healthcare system, despite all the tremendous resources that are there, is just not equipped to manage people in the home, and luckily, that is changing in lots and lots of ways across the landscape. But, you know, we’ve got our own little corner of it, which is to help people achieve what we call medication success, take their meds as prescribed and on time. And it sounds like a modest goal, but it’s one that when achieved, can have such an incredible impact on people’s lives and their health, and what they’re able to do in their lives.

Rich Prest:
Yeah, 100%. So just when you sort of step back and think about US healthcare overall, is there anything you can think of where, I think it’s not common knowledge, I think this is a space where many people don’t understand the complexity, looking, looking in, and kind of curious what you would see as a key factor that people just don’t understand.

Chris O’Brien:
Well, I think there’s just so many that come to mind. I mean, certainly the opaqueness of the drug distribution channel, I think, is a surprise to many. And I’ve worked with pharmaceutical manufacturers now for the last 10 or 12 years and found them to be almost entirely full of incredibly well-meaning people that went into it to really try to help people and serve their businesses, and they have to make money, but they take colossal risks on the investments they make to develop drugs or acquire drugs. And you can argue about what the price of any given med should be at any given time. And there are some incredible egregious examples of people raising the price of any drugs, but drugs that are necessary generics and impact people. And, but obviously, most of the companies don’t do that, right? And would never do this sort of thing. So I think just the role that that that middlemen can play, PBMs and others, and actually inflating the cost of drugs and even working against copay cards and things like that that can really help patients is not well known. And I think the other thing that I would say just more close to home that’s not well known is what a role that patients can play in their own health and when they’re supported in the right way, which I know some is focused on as we are, you know patient behavior can be changed. It’s very, very difficult and it doesn’t work every time. But it’s not the case that someone who just stops taking their meds won’t start again or can’t be helped, especially if you can reach them in that moment, in near real-time, as we call it. And we see the same thing, that last mile in healthcare is a lot longer than a mile. It’s, and it’s the most important part to helping to reach people where they are. And of course, where people are is very culturally and economically driven, like certain people and certain groups of people have not been well treated historically by society at large or the healthcare system, and those are the ones that we’ve been very focused on helping to reach here at AdhereTech as well.

Rich Prest:
That’s awesome, yeah, I think there’s often these sort of sweeping generalizations about people that are just not going to take their meds, and I think that sort of misses the point that it’s not black and white, that there are, if you can help, 5%, 10%, 15, 20% of the population to improve a little bit, that’s making a big difference for those lives. And that’s how we eat away at this problem, it’s not like there’s going to be some silver bullet that fixes it all in one easy step, so.

Chris O’Brien:
Yeah, I think that’s right, and, you know, we think remote patient monitoring, which is kind of our piece of it, is really important, but so is dealing with the economics, and I know the way that’s … and supporting patients in other ways. And it’s going to take a village of different solutions, some of which will work for one person and some for another person in order to make that all happen.

Rich Prest:
Yeah, I think that’s right. If you did have a magic wand and you could change something about US healthcare overnight, what do you think that would be? Yeah.

Chris O’Brien:
The alignment of economic interests with people’s health and outcomes. And it is changing in ways, actually, I think that probably could have been a different answer to the earlier question around what people don’t know, but value-based care is actually really become real in so many parts of the healthcare ecosystem now, especially primary care for the Medicare Advantage population, but starting to happen in oncology and lots of other areas as well. And it’s you know, it’s slow, but there’s been real meaningful progress even in the last 3 to 5 years. And, of course, COVID is only accelerated that. So I think it would just simply be if people got paid based on the improvements to people’s health that they were able to create or support, we’d be a happier, healthier society.

Rich Prest:
Yeah, I think that’s a great point, yeah. Value-based care may well be one of those ones that suddenly becomes an overnight success, right? Everybody’s been putting it down and saying nothing is happening and it’s been quietly moving along and I think acquiring more steam, as you say, so it’s definitely going to be a space to watch, I think. Yeah.

Chris O’Brien:
It’s a project of many decades for sure, but, and a lot of infrastructure has to get built. And I think it’s being built right now under our noses without us even seeing it.

Rich Prest:
Yeah, no, that’s excellent. So are there any, when you think about key trends or developments that are going on or regulatory changes, are there any that you’re watching very closely? Yeah.

Chris O’Brien:
Closer to AdhereTech’s world, I think we all have lots of devices with us now, smartwatches and miracle phones that have more computing power than the enormous room-sized computer I used 20 years ago or 25 years ago in telecom. And I think what people may not know is that something as simple as an Apple Watch, or not as simple, but there’s a lot of things that go into this and a lot of different companies and a lot of innovation had to occur in terms of creating really small power-efficient cellular modems, for example, creating different sensors and systems on a chip that allow something this small to actually work for as long as it does. And we, I think in healthcare, the beneficiary of a lot of these trends, at AdhereTech, we develop smart devices that help keep people on medications longer. Here’s an example is, one of our smart bottles, and the way that it works is it has sensors. We know when it’s opened, see, there’s lights and chimes that go off to help a patient remind them of their dose, but there’s also a cell modem and a battery that was originally intended for other purposes. So we’re constantly connected to our back-end cloud platform and helping us to remotely monitor patients around their medication behavior. And all of this is really only become technically possible in the last few years, really driven by lots of other trends in consumer electronics with startup companies like ours. The beneficiary, now, we couldn’t have built something like this five years ago.

Rich Prest:
No, it’s very cool. Yeah, it’s, yeah, really just remarkable what’s being done with this technology that we have now so accessible to us and I think will continue to amaze us in, in future years, how people keep coming up with new innovations, so yeah, absolutely. And also, as you say, it’s an amazing how it improves the economics. And just thinking about, I think VR was another one, right, where, you know, the advances in cell phone technology brought down the price of VR tremendously. So yeah, amazing how, how these things work. So when you think about, I mean, you’ve had a lot of experience with trying to bring in innovations in various markets. So what have you found are some of the key challenges to introducing innovation in the healthcare market? And what do you see … the key lessons? Yeah.

Chris O’Brien:
Well, you know, it’s I think similar to it a little different than just the general challenge of innovation introduction in that, you know there’s a really great book in technology marketing called Crossing the Chasm that was written, I don’t know, probably eighties or early nineties, and it’s all about how early companies can find that a few early adopters who are willing to take their initial product, which is unfinished and doesn’t really solve the whole job, and there’s the phrase completing the product, they’re willing to take this product that’s got a good core and do everything else around it that almost everyone else won’t. And you sort of believe in the beginning that that’s, that they’re going to find lots of people like that and they’re very hard to find anywhere, but especially in healthcare, and again, especially where the economics are fee-for-service or just not aligned with outcomes, right? Because the promise of remote patient monitoring technology is of various kinds is actually knowing what’s going on with the patient and in the home. And if you’re in a fee-for-service model, you might like that as a person, as a physician to be able to have time for that, but you don’t have economics for that, right? Whereas in a, if you’re in a Medicare Advantage value-based care setting, you do have economics for that because you’re on the hook for the health of that patient overall. And if you’re in the right kind of specialty pharmacy, you are, also have economics for that because you’re supported by the, either the manufacturer and/or the payers and the PBMs to help keep people on therapy longer. And so I think we see that places where those economic conditions have been created, there’s just actual behavior change from some very, very large healthcare organizations, and that allows innovation to be adopted. But without those incentives being there, it’s of course, much more challenging.

Rich Prest:
Yeah, so one challenge is to find those visionaries. It’s probably going to be less than 5% of the total addressable market. And then to find them in a setting where there’s actually a possibility for them to adopt your technology.

Chris O’Brien:
That’s right, you know, in healthcare, I think there’ve been so many promising technologies to just have failed to be adopted on either for lack of those early adopters, but even more commonly, when you find those early adopters, you then still have to get patients to use them. And it’s challenging, you just think about all those apps out there that people can use to track medications or track their steps and their lifestyle change and change their lifestyle. And of course, patients may download them, they may register, they may not, or, I’m a person who spent the majority of my adult life trying to get people to click on things and download things and fill out registration forms, and it’s really hard to do. And even once you do it, it’s they often don’t. And at AdhereTech, really, part of the genius that the founders had here was if you could use a pill bottle, you can be in the AdhereTech program. You just use our pill bottle like a pill bottle. Don’t need to have an internet-connected home, don’t need a smartwatch, don’t need a smartphone, nothing. And it’s just really, really important because, you know, everybody thinks, oh, everybody has a smartphone now and it’s not true, and even if you do have one, you may not know how to use it or how to sync Bluetooth devices and all the rest of it. And so we just think from reaching every patient where they are, no matter what their economic straits, no matter what their housing situation is, we have homeless people that are using our bottle, charging it like they do just a walk up access points, etc. It’s just really, really critical from a health equity perspective to not assume very much at all about what kind of digital infrastructure may be around a patient.

Rich Prest:
Yeah, yeah, and AdhereTech’s really, you know, the founders got in very early with this technology, and probably to your point, earlier point had probably had some challenges with where they were on the cost curve with this, you know as you sort of think about the future for AdhereTech, what what are some of the things you’re excited about in terms of product development and where do you see this sort of the most market opportunity? Yeah.

Chris O’Brien:
Well, today AdhereTech largely works with pharmaceutical manufacturers that make specialty medications, so generally the more expensive medications. And the reason that’s important is simply because they have their money they can use to help support patients. It’s certainly not the only funding model we could use. We could work with payers as Sempre does as well, and we certainly intend to do that over time, but it’s a great way to get started because it’s relatively easy for a small company to go out and get a several thousand-patient program going, and that lets us generate real data about the kind of impact we can have on patients and their outcomes. And so just in some recent programs that we’ve run in oncology, we were able to keep, in one case, 50% more patients on the medication compared to a control group at 12 months on therapy, which is enormous. And then just very recently, another oncology drug from a different company, we saw a 70% more patient still on therapy at month 11. And so the power of real-time monitoring and real-time connections to care, it really has an impact on patients. And I don’t think it’s the technology that’s having an impact on patients, I think it’s the technology giving the healthcare system the information they need to know which patients need help today. I think that’s the promise of this type of technology, because our platform, a smartphone app, is not going to change behavior, but your pharmacist calling you might, your doctor calling you might, your doctor say, hey, come in, I see you’re having problems with the medication and then having a real conversation with you about why it’s important to take and dealing with your affordability issues. People can change people’s behavior, and I think that’s what our platform really enables.

Rich Prest:
Yeah, no, I think there is this amazing sort of triangle between the technology that spins off this data, the analysis of it, working out what needs to happen, and then that ability to either nudge a patient up close with the bottle or to actually bring in a human and have a human-human conversation that can provide that right motivation, so, yeah, that’s cool. In terms of the, you know, when you think about sort of clinical trial type applications versus, because I know one of the big costs for pharma has always been, you know, getting enough people into a trial, and one of the challenges has been they make an assumption about the adherence that’s going to occur during that trial, and that drives up the need for more participants. So are you starting to see some interest from pharma in using these in a trial situation so that there are less enrollees needed for the trial?

Chris O’Brien:
We are, actually, yeah, just recently we’ve now done, we’re on our second clinical trial. We did a small one last year and then are doing a larger one now with patients in the US and Europe, diabetes actually through …, they’ve been a great partner to us. And one of things we realized is that the products we have on the market now are our bottles so that you, the patient is generally getting a refill once a month, transferring the medication into our bottle, which in a post-approval setting is mostly fine, but with, in clinical trials, especially earlier stage ones, the stability of the medication has not been established and there are very carefully constructed supply chains to randomize patients and mail the right meds to the right study center, or that now increasingly the patients’ home. And the idea that patients would then take them out of these hermetically sealed bottles, the pills, and transfer it to another one just, it’s, that makes getting into innovation adopted quite a bit harder, let’s put it that way. So we have a new product coming out in a couple of months, which is a smart cap. It’s very much like our bottle, it has a little screen. I don’t have one here because it’s still in manufacturing, but it’ll go over the top of an existing bottle, still have reminders, that little screen, so you can actually handle complicated titration cases, which is very important when patients start the Med. And the feedback we’re getting is that that will be more much easier to adopt in clinical trials because there’s no, we’re not touching the Med anymore. It’s just no issues of stability to be dealt with at all.

Rich Prest:
That’s very cool. Yeah, and just a great example of how it’s not something you’d anticipate, right, that that would have been an objection for use in trials, and then when you get into it and you discover that sort of thing, that’s when you get those insights and the shifts in product direction that will enable you to help that market and get that product market fit that can.

Chris O’Brien:
That’s exactly right. Yeah, so we’re very hopeful about that opening up additional clinical trials for us. And of course, there are a number of medications on the market that do have an FDA label saying they should not be removed from their original container. So we have, our launch partner is actually one of our current pharmaceutical company partners for the product and they have such a label, they wanted to work with this brand, just wanted to work with us for a long time. It’s quite a big brand and they’ll be able to now because we’re again, we’re not touching the Med, and I think that will open up other distribution channels for us too, because pharmacies are great partners, partially because in the US they have the legal right to repackage medications for the patients’ health. Which is actually not common around the world, it turns out in Europe they can’t actually do that, but in the US they can, and so that’ll let us work, I think, more directly with payers and PBMs and others who’ve been interested in working with us, but I’ve just felt uncomfortable recommending a different medication container.

Rich Prest:
Yeah, yeah, that’s absolutely the case, I think, very cool. Well, that’s exciting stuff. So in terms of recommendations for someone’s getting a start in the industry, would you, what would you suggest having done many things in the space? Yeah.

Chris O’Brien:
Well, I don’t know if my career trajectory has been really typical, but I will say that I’ve learned a lot more, much more quickly in my smaller company jobs than I have in my bigger company jobs. I think big companies have gotten really good at just systematizing things, and it can be a great way to start. I think I was really glad to have started at AT&T in my youth. They had great training programs, great support for education, and just great to see the infrastructure there. But for me, at least after two or three years, it was time to go do something else. And I did it the hard way, but I think, find a young and growing company, maybe after you’ve worked at a bigger place and gotten your core skills down and join that company and you, if you’re good, you’ll find the opportunities for advancement and really just knowledge creation for yourself are much higher than they would be in a larger, more structured environment.

Rich Prest:
Yeah, 100% agree with that. That’s definitely been my experience too. So I think sometimes people have a little comfort from having that big name on the résumé, but wow, the learning really does come in the small companies.

Chris O’Brien:
Yeah, it’s never a bad thing to go, start your career in a big company and then advance in a number of smaller companies and maybe even go back to a bigger company. I did that a couple of times and it worked out well.

Rich Prest:
Awesome, cool, any podcast or book recommendations for the audience? Anything you found particularly useful, helpful?

Chris O’Brien:
You know, probably not right now in healthcare, actually. Interestingly, I tend to work a lot and so I tend to do my reading outside of healthcare. But one book I read recently that just blew my mind was, it’s a history book called Britain After Rome, and it’s about the collapse of society in Roman Britain. And just, it’s just fascinating because it was a version of that sort of dystopian future that we all fear sometimes. And you forget how much technology is around us at all times, and when the skills to make that technology go away, Rome is a very advanced society and medieval Britain was much less so. And so people forgot how to make stone buildings and build certain kinds of wells and certain kinds of irrigation, and all of a sudden population collapsed, and no written records. And just, it’s a scary thing to imagine.

Rich Prest:
Oh, that’s that sounds really interesting. Yeah, yeah, always, my dad’s a historian and he’s always reminded me how many of the things that happened to us have happened before. We’re not that unique, special, or different than the generations that came before us.

Chris O’Brien:
That’s right, it’s always the big argument because everyone always thinks things are getting worse. But by any normal historical standard, things are better than they’ve ever been for almost everybody in humanity.

Rich Prest:
Absolutely, cool. If folks want to connect with you online, where would you recommend they do that?

Chris O’Brien:
Linkedin is great and/or just come to the AdhereTech website. We’ve got a form you could fill out and people actually read the inquiries and we get back to people.

Rich Prest:
Awesome, yeah. Are you guys hiring at the moment? Looking for additional folks to?

Chris O’Brien:
Always, always looking for life sciences, sales folks, it’s a very difficult market to hire in. We’re always looking for data scientists, good engineers, product, it’s been a challenging area for us to hire in. We’ve got a great head of product who is … patients like me and Adhere therapeutics, so just incredible guy. But yeah, just finding those young, hungry product managers is always a challenge.

Rich Prest:
Absolutely, no, it’s a great one. It sounds like people can go to the website and see what those opportunities are.

Chris O’Brien:
Absolutely.

Rich Prest:
Yeah, well, thank you, Chris. It’s really been fun to chat with you and catch up and excited to hear about all of the cool things you guys are doing at AdhereTech. So yeah, and to the audience, thanks so much for tuning in. I hope you got something of value from the episode. If you did, please don’t forget to review Sempre Health podcast on your favorite streaming service. It really helps others to find and enjoy the show. Thank you, everyone.

Chris O’Brien:
Thanks.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

Automatically convert your mp3 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you’d love including secure transcription and file storage, transcribe multiple languages, collaboration tools, share transcripts, and easily transcribe your Zoom meetings. Try Sonix for free today.