Dr. James Min, Founder & CEO of Cleerly Health, on Building a Cardiology Care Management Platform

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Dr. James Min, Founder & CEO of Cleerly Health

For the third episode of the season, we spoke with Dr. James Min.

Dr. James Min (Jim) is the Founder and CEO of Cleerly Health, a digital healthcare company helping clinicians diagnose atherosclerosis at earlier stages of the disease. The company’s AI-based platform non-invasively analyzes coronary images for plaque build-up in the heart’s arteries to identify signs of coronary artery disease, in a simpler, faster, and more accurate manner than traditional methods.

Jim is a board-certified cardiologist with a clinical focus on cardiovascular disease prevention and cardiovascular imaging. Cleerly is based on Jim’s research that he has been doing for approximately twenty years as a former Professor of Radiology and Medicine at Weill Cornell Medical College and as the Director of the Dalio Institute of Cardiovascular Imaging (ICI) at New York-Presbyterian. Jim is also a Past President of the Society of Cardiovascular Computed Tomography and a leader in the American College of Cardiology. Min received his BA from the University of Chicago, and his medical degree from Temple University Medical School. He completed his internship, residency and cardiovascular medicine fellowship at the University of Chicago Hospitals.

In our conversation, Jim and I discussed:

• How being a truth seeker defined his career journey and ensures Cleerly Health does what’s best for patients
• The importance of determining the right questions first in order to naturally achieve product market fit
• Establishing a robust clinical evidence generation capability as a firm which is critical to determine what products to build
• How firms should be thinking about building GenAI products
• Why startups should make monetization a top priority

01:30 to 4:59 — How having a vision to uncover the truth in vascular biology led to Jim’s unexpected career in cardiovascular imaging

• On Jim’s career path: Jim’s fascination with creating new knowledge combined with the chance to be an early adopter of a new technology to directly benefit the lives of millions ultimately led him to the field of cardiovascular imaging. Cardiology had long been an area of interest for him, especially since it is the number one cause of morbidity worldwide, but it wasn’t until he saw an early version of the cardiac CT scanner that he switched careers to focus on imaging. In this early version, Jim saw the possibility that clinicians could better understand coronary vascular biology and how it could improve coronary disease treatment.

5:00 to 7:25 — Setting the foundations of any healthcare company as a scientifically oriented firm

• On why healthcare companies should be scientifically rooted: If it’s a scientific question worth asking, it’s worth doing high quality science through prospective, multiple center trials. Healthcare innovations have to be validated through rigorous studies as the stakes for patients are too high to just release newly created tools or devices to the public without testing.
• On how taking a science first approach requires a long-term orientation: Jim thought it would be obvious to others about how useful analysis of non-invasive CT scans could be for heart disease management. But it took 20 years to have enough data such that the American Heart Association & the American Cardiology Associations made CT non-invasive scan a Level 1A recommendation over other diagnostic tools for patients with stable chest pain.

7:26 to 13:46 — Cleerly Health’s mission

• On the problem Cleerly Health is solving: Cardiologists were historically focused on treating symptomatic patients to reduce the levels of heart attacks and strokes in the population. But new research shows treating the symptoms of heart disease only relieves symptoms and doesn’t tackle the underlying disease. One reason why the historic treatment paradigm focused on treating symptomatic patients is because it is difficult to identify asymptomatic patients. More than half of heart attack patients are asymptomatic.
• On how Cleerly Health is fixing the problem: Cleerly created a non-invasive imaging tool that utilizes AI to extract all the relevant information to know what is happening within the arteries. Cardiologists can use Cleerly to stabilize the patient’s disease by tracking arterial change over time, especially post-interventions.
• On providing tools for both doctors and patients: Cleerly created a digital care management platform that allows all doctors involved in heart disease care to make informed treatment decisions. It provides doctors with a standardized, personalized assessment of heart disease evaluation and quantitative tracking to determine if interventions are working. A patient report with a patient-friendly analysis of their heart is autogenerated. By making it easier for patients to understand their disease, the report hopes to drive treatment adherence and follow-up.

13:47 to 20:31 — Founding a company from asking the right questions

• Through his clinical work at Cornell, Jim and his team created a program to manually analyze CT scans to identify a medication plan to stabilize his patients’ plaque. A manual analysis of one patient’s scan took 8–10 hours! Jim didn’t intend on starting an AI or imaging company but he identified that AI would be the answer to the question of how to scale his medical therapy program and allow all cardiologists to have the tools to help identify and treat asymptomatic heart disease patients.
• On identifying the right questions to ask: Jim’s advice comes from Einstein who said “If I had an hour to solve a problem, and my life depended on solving it, I would spend the first 55 minutes formulating the right questions”. What the product should be is a natural conclusion if you understand what are the questions you’re solving for. The evolution of Cleerly Health came from continuously asking questions about vascular biology and then answering those questions with large scale, five year trials. These large scale studies elucidated the truth about vascular biology through the trial’s statistical robustness, which was further supported by Jim’s clinical work at Cornell.
• On the importance of seeking truth: After asking the right questions, what matters is the knowledge and learning that comes from answering these questions. Cleerly has had plenty of studies that didn’t result in positive outcomes, but even negative outcome studies helped them better understand vascular biology. If you’re not seeking truth, then your biases will blind you and make it difficult to provide the best patient care.

“Seeking truth is what matters as it equips people to take better care of patients.”

20:32 to 24:55 —Cleerly Health’s product development framework

• On how Cleerly determines its product roadmap: Identifying what products to build comes from understanding what the answer is to the right questions. Instead of creating a product and trying to find the right customers, Cleerly develops their products by figuring out what use cases or problems doctors have. This process is done by asking what the right questions are. From there, the team determines what the right product to build is. For example, Jim realized that an automated solution to analyze CT scans was needed to facilitate more patients getting access to the kind of care he was providing at Cornell, so he created Cleerly to do this.
• On collecting patient stories to inform the product roadmap: The best questions always come from patient questions or interactions that stump clinicians. You’ll know it’s a good question if a doctor says “I don’t actually know what the best thing to do here is because the answer doesn’t exist in science yet.”
• On how developing a firm culture of truth seeking keeps Cleerly Health agile: Following an evidence based process to create products should naturally result in achieving product market fit in time and allows companies to stay ahead of the latest technologies. Truth seeking firms can pivot their plans and will make radical shifts to adapt to changing business environments because it’s the right thing for patients. Creating a firm culture that prioritizes truth seeking through this evidence based process is critical.

24:56 to 27:17 — Generative AI (GenAI) applications in cardiology

• On advice for how GenAI should be developed for healthcare applications: The field is working towards developing AI that can identify insights that an individual reader wouldn’t notice. But AI is just a tool that augments one’s abilities. Companies developing AI solutions should focus on developing AI with that perspective in mind and consider how the AI will support specific clinical use cases.
• On how GenAI may be incorporated into Cleerly Health’s products: Cleerly Health is exploring how generative AI can have useful clinical applications in heart disease and allow doctors to more precisely identify patients with early stage heart disease. The company is embarking on a landmark study to research these applications.

27:18 to 32:12— Value based care in medtech

• On prioritizing monetization: Jim cautions firms to not get enamored with a product and forget that someone needs to pay for the product. Firms should proactively strategize how to monetize by thinking about why a customer would pay for a product like yours. Value add firms must provide their customers improved outcomes and cost savings. Because of this, startups need to ask themselves “how does our product or service help people and how does the firm do it at a reasonable cost?”.
• On the future of medtech reimbursement being value based: As the dominant payment systems move in the direction of value-based care, medtech companies should consider how to partner with customers in these types of contracts.

32:13 to 33:02 — Advice for life science leaders

• On challenging dogma: Looking back at Jim’s cardiology fellow training, most of it is out of date now as the field has gathered new information thanks to people, like Jim, who sought to find the truth. Be a truth seeker. Science advances and patients receive better care when you challenge dogma.