Ep #481 The Gut-Brain Connection: Exploring Digestive Health with Bill Snyder | ShiftShapers

Speaker 1: 0:00

We're often told to trust your gut, but medically that might be a bigger problem than you think. What if your gut isn't healthy? We'll find out on this episode of Shift Shapers. David, thanks so much for having me on.

Speaker 3: 0:59

Absolutely. I spent over a decade at Humana so really learned the industry of healthcare, moving all around with them and looking at all different aspects of the business. From there I went and worked in the diabetes space at an early stage company called Verda Health. One of the things that I saw over time was I knew friends and family members who suffered from chronic digestive conditions. I really saw that the way that care was being delivered left a lot of gaps and left people feeling alone, feeling isolated. That was really the catalyst for starting our work at Vivante.

Speaker 1: 1:34

It's interesting. We all have different paths. You and I actually semi-cross paths when we were both at Humana years ago. There's a lot of us out there and you know who you are. We find each other through strange things. It's fun to come back full circle and see what you're doing today. Let's talk about the problem. What is the problem and how does it affect spend? That's really what it's all about. I mean, secondarily, employee health.

Speaker 3: 2:04

David, you said something on the onset that's so true, which is a lot of people are surprised to find out how big this problem is in terms of scope. One in four Americans suffer from a chronic digestive condition. There's so many more that are suffering in silence that have yet to be diagnosed. When you think about this condition set, it's really broad. Digestive health is an umbrella term and that includes conditions like ulcerative colitis, like Crohn's disease, like irritable bowel syndrome, like GERD.

Speaker 3: 2:32

But there's also a large population who are suffering from symptoms like abdominal pain or chronic nausea. They don't really know where to go. They don't know if they should go to a primary care physician or a specialist. A lot of them are self-medicating and a lot of them think maybe this is just how I feel and that translates to a significant number of claims for plan sponsors, whether those are health plans or large self-funded organizations. And from a personal perspective, it means people are struggling, they're suffering in silence, they're feeling alone, they're feeling isolated and a lot of these conditions are highly correlated with stress and anxiety because of the gut brain connection. So it's a massive problem in scope, a significant spend associated with these conditions. It's often the number one reason for emergency room admits across the US, and so people are always surprised to hear this, but we're seeing a lot of employers and health plans really recognize that this is a considerable amount of spend.

Speaker 1: 3:31

If you do find yourself in an ED and you've got some condition, what might you be feeling? Is it just an upset time of year? Is there a whole range of diseases that we're now starting to understand come from gut health and from that bio?

Speaker 3: 3:45

Yeah, it's definitely a range. We see a lot of abdominal pain. We do see that nausea that we talked about, but we see things like constipation. We see things like chronic diarrhea. I mean individuals who really struggle to go to work and show up and be productive. And again, the problem with these conditions is if you don't catch them early, then by the time you need help, oftentimes you're going into the emergency room and so we see it as a leading cause for admits and oftentimes a secondary reason for other admissions. So high correlation to other conditions outside of just digestive health.

Speaker 1: 4:21

Is this something that the medical establishment is up on? I mean, we often hear that when there's a new technique or a new way of looking at stuff, it takes 10, 12 years until it filters through the entire physician or provider or clinician. Let's call it that, let's use clinician setting. Is this something that, if you're going to see your good old family doctor that they're aware of, and or at a hospital, what's the awareness level?

Speaker 3: 4:46

I think that it's.

Speaker 3: 4:48

It's increasing, and one of the things that's really unique about this space is because there are so many different conditions and because there's not a single biomarker that tells patients hey, this is what you have or this is how you're doing.

Speaker 3: 5:01

These are very nebulous, and so it's a great opportunity where a digital intervention can supplement the care that's being provided in traditional brick and mortar, because it's capturing a lot of disparate data.

Speaker 3: 5:14

You know, at Vivante, we're able to start leveraging pattern recognition to say, hey, we understand what are kind of the predictive markers of somebody having these conditions and having a flare up, an episode associated with these conditions. So I would say that there is awareness, and when you talk to physicians, a lot of them will say these are really difficult conditions to help fully support the member, because it's a lot of point in time work, it's outside of the office, so what happens when that patient goes home and goes back to work? And so what we found is an extremely receptive relationship with providers for us to help enhance their work, and that's something that we're really keen on is we're not looking to replace the providers. We're here to supplement the work that they're doing. We're here to find those high acuity patients that maybe need to go in to a brick and mortar and work with a gastroenterologist or another physician and do all the work outside of the brick and mortar to help mitigate those symptoms and get people feeling better.

Speaker 1: 6:13

Are there modalities or testing, other than just symptoms, that help the clinicians come up with a differential diagnosis and say aha, this is not something you know. It looks like your intestines aren't screwed up or whatever. This is a gut thing, and we know how to go about treating it. Is that happening yet?

Speaker 3: 6:34

It is, but only for specific conditions. So there is some lab work and then of course there's scopes for more significant conditions that can be done, but for kind of that broad set, a lot of it is still diagnosed by elimination and so it is time intensive, it's work intensive, and so if you can imagine a patient experience who needs to first of all find a provider, then take time off work, get that time scheduled, be able to go into the office, have that meeting with the provider and then maybe two months later, fine, go back to that provider or to go see a specialist, that's pretty intense. And for us to be able to do that with a member digitally with our remote care team can really expedite that diagnosis procedure and also make sure that we're getting them to the right care at the right time.

Speaker 1: 7:21

So if you're a health plan and you're paying claims, what does this look like? What kind of a dent is this gut health stuff making in your claim spend?

Speaker 3: 7:29

It's really significant and so you know we see, on average, an individual suffering from a chronic digestive condition costing over $17,000 a year in claim spend. We see some of the medications associated with these conditions, sometimes over $70,000 for high-cost biologics for a specific individual. We also see a lot of unnecessary utilization, so again that kind of really high admission rate to emergency rooms across the country. We also see a lot of duplicative use, so we see these patients going to a number of different providers in that journey of trying to figure out what's going on with me. So we're seeing it as a significant portion of claim spend and I think that the health plans have really recognized that and so are really working with organizations like Bobante and with the providers to make sure that they can provide better care and better coverage for individuals with these conditions.

Speaker 1: 8:28

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Speaker 1: 9:04

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Speaker 3: 10:03

Yeah, it varies a little bit by provider and by symptom, and that's a lot of the problem. There's no kind of core answer. There's no. You should see that every member should go see a gastroenterologist, or every member should go see an internist, or everyone member should work with a registered dietitian, because that's something that we leverage and has been life-changing for a lot of our members, and that's part of the battle is from a patient experience is finding that right provider and figuring out what provider makes sense for their specific symptom or their specific condition. And that's something at Vavante that we do. We optimize the triage process. We make sure that we understand the member and get them to that right care provider at the right time, because that is a big part of the struggle.

Speaker 1: 10:46

There's such a wide range of conditions. I mean, I think I've even read an article recently that links gut health to Alzheimer's. How, as a patient, do you know to reach out?

Speaker 3: 10:59

Yeah, I think what we've found is a lot of the patients that we connect with have been searching for a solution, and we a lot of the patient stories that we get are this is what I've been looking for. You know, I've been suffering for this not for a month, not for three months years, decades. We have people that say I've been looking for a solution for 10 years. So it definitely is. The onus tends to be on the member, but it's making sure that they know that benefits like this are available to them, and so that's why we work with consultants, brokers, large employers, health plans to say, hey, here's this great benefit and just making them aware we're seeing a really high rate of opt-in to the solution compared to other Digital health solutions. So I think that's telling in terms of the need there out in the market.

Speaker 1: 11:49

How are members reaching you? Is this something that's being written into plan documents, or just a huge educational campaign at the employer level? What's what's that all about?

Speaker 3: 11:58

Yeah, it's a good question. So for us, one of the key things that we do is we do take an all-comers approach. So when we work with health plans or employers, we say, hey, there's a really good reason to make this available to everyone. We can do kind of a claims-based kind of focus, but we don't recommend that, and the reason is that big population I talked about that doesn't have a formal diagnosis today. That's suffering, that's that's. They're the ones that are ending up in the emergency room eventually, or they're the ones seeing a bunch of doctors today but don't have that, that formal diagnosis, and so for. So it's definitely a general awareness campaign. At the Vante we do everything for the employers, so our goal is to make it very simple and easy for employers and health plans to launch us. So a completely custom marketing campaign where we're doing multimodal outreach, whether that's through technology or even things like postcards with QR codes for the members to opt in, very simply, and we found that to be highly effective in terms of creating awareness.

Speaker 1: 13:00

It's a challenging problem to solve, I think. Is there any way to do any kind of predictive modeling yet on this stuff? Is there enough data both on the condition side and on the patient side?

Speaker 3: 13:16

So there's some, and I would say for us that's a big focus.

Speaker 3: 13:21

What we're getting really good at is leveraging that data to predict the onset and progression of these conditions, and what we've done on our technology end is to be able to build these evidence-based clinical pathways based upon the symptom and the need of the member. So somebody with ulcerative colitis who's working with a gastroenterologist, who's been taking a medication for 10 years but is looking to optimize their care in between visits, when they come into Vante, they have a completely different experience than someone who comes in and says, hey, I've got abdominal pain, I've got chronic nausea, I don't really know what's going on or where to go. And so our technology will take that intake, understand the member, build an evidence-based clinical pathway based upon their unique symptom and or condition, and then it's a learning program. So the more we interact with the member, we continue to adjust the program based upon those ongoing interactions and at the same time, with our members' consent, we're collecting information, collecting data, so that we can improve our algorithms and improve our prediction models.

Speaker 1: 14:24

In our conversation. Bill, you've mentioned a couple of conditions. Give us a few more. What are the things if I'm not feeling well in a particular way? What are those things that I should look for and how might I be feeling before I need to reach out to somebody like Vante and have them help us?

Speaker 3: 14:40

Yeah, I think, in terms of when you look at the distribution of these conditions, irritable bowel syndrome and GERD are the most prominent. And so, with irritable bowel syndrome, that might start with. It might start with cramping, feelings of bloating, sometimes feelings of nausea. With GERD, that's going to be that significant heartburn that oftentimes doesn't seem to go away and oftentimes causes people to lose sleep and again increases that stress and anxiety. Things like ulcerative colitis and Crohn's disease well, oftentimes much more severe, are much lower in prevalence, although we see that a lot of ulcerative colitis and Crohn's people patients who suffer from Crohn's disease as well enroll. But that's kind of the distribution is IBS and GERD is a bit more relevant. So those are some of the things that you're thinking about is abdominal pain, that chronic nausea, that feeling of bloating, that sometimes feeling of blockage, and I think that the key here is what we see a lot of patients feel like is I have to live with this, like I've had this forever, because again, it's stuff that happens.

Speaker 3: 15:45

People have had it for a decade and they've said, well, I guess this is just how I'm supposed to feel. And so I think what's really exciting about the work that our coordinated care team does. We have this incredible Clinical care team that works with individual individuals and we're identifying things like trigger foods that are causing inflammation in the gut, and, instead of saying you need to radically change everything you do and you eat, we're able to pinpoint Specific things that that individual member is eating that's causing this reaction, and we're saying, hey, take this one thing out for the next two weeks. And we have people that say, hey, I've been to multiple doctors and I've been scoped and I haven't been able to get a diagnosis. And now, working with the body after 12 weeks, I've identified a trigger food and I've gotten my life back. And so it's really incredible what we're able to do with that kind of specific identification.

Speaker 1: 16:34

Well, I mean, gerd is a huge, huge problem. Wasn't, wasn't the initial drug for Gerd, the first billion dollar drug in the marketplace, years ago?

Speaker 3: 16:42

It was, and, and what's amazing about Gerd is when you look at some of like the Medications that people take, a lot of times we will take the medications incorrectly or at the wrong time, and so there's little simple fixes from a behavior change model that we can implement, like medication reminders, and what we see is individuals who work with us do have better medication adherence than those who do not. So it's some of those little things that sometimes we're Identifying medications that are unnecessary. Oftentimes we're finding medications being taken incorrectly and helping adjust that for the member, and it's stuff that they say hey, you know what, when you're in the doctor's office or when you're picking up your prescription, maybe you're thinking about other things and so you haven't had the time to really review how to take that medication properly, which happens to all of us, and so for us, you know, having that that kind of constant feedback loop and that monitoring has really helped individuals improve from a poll host of symptoms.

Speaker 1: 17:34

Yeah, I know you're not part of the clinical team. I'll put you on spot a little bit. Is is it? Is it oftentimes, when you're talking about the one food that maybe you should avoid? Is it oftentimes something oblique? It's not like, okay, stop eating pepperoni pizzas.

Speaker 3: 17:46

It's something like you know, cantaloupe or something weird it is, and there's all kinds of things that, again, we view is healthy. You know, we see a lot of members come in and say, hey, I've been eating broccoli and you know I'm really trying to eat well, and it's like, hey, you have an adverse reaction to broccoli or a specific type of nut, and so there's and there's a huge variation or people that even develop Intolerances later in life. You know we have lots of members. You know people can develop lactose intolerance At, you know, 45, at 55, at 60 years old, and so there's, you know, individuals that you're not used to, that you're.

Speaker 3: 18:26

You've grown up your whole life ingesting certain types of foods that have never had an adverse effect and all of a sudden something's happening and you can't pinpoint why Because you haven't changed anything but your body's changed, and so I think that's something that we find often, and you're absolutely right, it's not just kind of hey stuff that we kind of know is not great for us. Oftentimes it's it's food that is very healthy for other individuals but for whatever reason, that specific individual Can't process it effectively and that leads to inflammation and all these symptoms.

Speaker 1: 18:58

Yeah, I just read an article about late onset lactose intolerance at something I'd never heard of. But I was having a problem Switch to lactose free milk, boom problem solved if I hadn't happened upon that article. And I read a lot more than the average beer does because I do these podcasts and help advise folks. It's so strange, I mean what? Talk to me a little bit about the Go circle back a little bit. Talk to me a little bit about this alleged link, or per proposed link, between Alzheimer's and gut health.

Speaker 3: 19:27

Yeah, so so what we know from a lot of great third-party research is the gut brain access is very real and so that is kind of the biofeedback loop between the mind and the gut, and so we know that things that are happening with your digestive health absolutely impact your everyday mood, your feel it can lead to if you're, if you're having issues.

Speaker 3: 19:50

We see a very high correlation with things like stress, anxiety and vice versa. So, in terms of Alzheimer's, the studies that are coming out are really exciting and they're also relatively new and novel, and I think what's so incredible about this space is there's so much opportunity and there's so much that's still being learned about the gut microbiome, digestive health and its connection to things like Alzheimer's and other conditions. So we've been able to identify that, that gut brain connection. You know we provide tools for individuals, like cognitive behavioral therapy for patients with IBS, which we know is a first line of defense to mitigate those GI symptoms and get them feeling better from a mental health perspective. And I think what we'll see is these connections to things like Alzheimer's and other conditions will be continued to be more and more studied and understood over time. So for us that's that's really exciting, it's something that we're really focused on for the future state of the organization.

Speaker 1: 20:48

Are you sharing data any place outside of your organization? Obviously, de identified data, but are you? Are you sharing data to help people like maybe start building databases and and tracks to understand how to ping these symptoms back?

Speaker 3: 21:02

So we are doing some some data sharing with certain partners. One of the things that I always talk about with us as an organization is we take data security very seriously, so we are sock to certified or high trust certified, which is a organization at our stage Not not everyone is, and when we say, hey, that's in our DNA, we take that very, very seriously and so. But with that, it also allows us to do some really interesting work with some of the health plans and some of the larger employers that we're working with. I also think you know we're using that data for clinical studies. We're going to be. We've done a couple of abstracts, which are really exciting. We've got more that will be coming up. So we're very excited about some future publications that will be providing, because our goal is to impact the members that we serve, but also the broader community, because we think we can really push forward some of the scientific work that's going on in this area.

Speaker 1: 21:56

For our audience, which are primarily consultants who are client facing. We have some other folks, obviously, but that's the best majority of our audience. Where do you guys interact? You do small groups, large groups, self funded groups only. What's your comfort level on those?

Speaker 3: 22:10

Yeah, right now we've focused on larger self funded groups to be to begin we are again. We have the capability to build through claims as a, as a provider, through health plans. That's very attractive to those self funded buyers. We are quickly moving into what I would call mid market as well and so can certainly work with fully insured and self funded groups. But but typically I would say you know we're looking at A thousand employees and above as a starting point for now. Over time our hope is to move much more into the fully insured market, small and and some of that lower mid market as well and do you connect to tps just as another provider?

Speaker 3: 22:52

The great question. We do work with tps and for any anyone listening, any brokers and either party administrators we do that really well. And going back to our conversation about both our experiences at humana, from my standpoint, building this company, one of the core focus was how do we integrate into the existing healthcare ecosystem and that means working well with Brokers, consultants, tps, health plans, other providers, other point solutions. So it's definitely in our DNA and that's part of our ethos. So if there's third party administrators out there, we work with a bunch of them today. They're great partners and we would love to continue to grow those relationships.

Speaker 1: 23:30

So we've got about three minutes left and one of the ways we like to wrap up the podcast is asking kind of what's your vision for the future? If you can scope it out kind of near term, midterm and long term, where do you see this Going?

Speaker 3: 23:44

Yeah, absolutely so. Near term. You know, we're growing really, really quickly and what I'm excited about is the fact that the market is understood that this is a major issue, and so we've got health plans, we've got large employers saying this is a big issue, it needs to be fixed. So for us it's it's execution and growing through our health plan relationships and large self employer relationships. You know, the next phase for us is because there's so much opportunity here. We will look at different business segments. That can be things like Medicare advantage, it can be fully insured populations we're launching with one health plan and they're fully insured population just now. So I think, expansion into these other areas. But I do think for a future state, this is a very unique condition set that touches so many other conditions, and so I could see us broadening out our focus, working with other solutions as well, because digestive health is so highly correlated to other conditions, and then finally, organizing our data and utilizing it to influence other studies and really showing from a population level how important improved digestive health is.

Speaker 1: 24:51

That's a great place to end our conversation for today. Bill Snyder, ceo of a Vita health bill. Thank you so much for sharing your expertise with the audience. We look forward to having you back as the field expands.

Speaker 3: 25:01

Thank you so much for having me, david. I enjoyed it.

Speaker 2: 25:04

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