Jon Bloom, Podimetrics, on partnering with the VA to end amputations
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In this episode, we interview Dr. Jon Bloom, the Co-Founder and CEO of Podimetrics. The company’s mission is to improve patient lives through early detection and prevention of diabetic foot ulcers. They are a virtual care management company dedicated to preventing diabetic amputations through their SmartMat product and partnerships with both payers and at-risk providers, including the Veteran’s Health Administration. The company was founded in 2011 and has been backed by Norwich Ventures, Rock Health, Scientific Health Development, and Polaris Partners.
During this conversation Jon and I discussed:
- How Podimetrics’ technology is able to prevent foot amputations, a life-altering complication facing many patients living with diabetes
- How Podimetrics has built a successful relationship with the VA, and advice to entrepreneurs looking to do the same
- Thoughts on the future of digital health solutions in chronic care
Start to 10:00: Podimetrics helps patients by focusing on their feet
- Quick background on feet and diabetes: According to Mayo Clinic, diabetes can lead to nerve damage and poor circulation that make the feet vulnerable to ulcers. More than 80% of amputations begin with these foot ulcers, which is why receiving care to manage or, ideally, prevent ulcers is so important. Failing to do so could eventually require an amputation.
- Foot amputations are a surprisingly common complication of diabetes — each year there are ~200k non-traumatic amputations, with African Americans being 4x more likely to experience diabetes-related amputations.
- Jon’s inspiration for Podimetrics came during his training as an anesthesiologist. There were times that he would “spend whole days in the operating room doing nothing but amputations”, and many of these were a result of poorly managed Type II diabetes.
“How could we still in today’s age see a complication like that, especially when it’s largely preventable? Even something as easy as laying off your feet for a short period of time can stop this whole cascade before it’s this terrible wound you have to see me and the surgeon for in the operating room.”
- Finding the right form factor for a solution: Recognizing that patients most at risk for amputations were also likely to be overwhelmed by other comorbidities (e.g., heart and lung disease), Jon believed that enabling patients to engage easily with the product was paramount. When trying different form factors (including shoes, insoles, and socks), the team found that a mat had the best adherence by far.
- How it works: The SmartMat product is wireless and has a built-in cellular connection, so users don’t need to sync anything to their phones or remember a WiFi password to share their data. Standing on the SmartMat for ~20 seconds a day collects information on temperature values across the entire foot, which helps identify an inflammatory signal suggestive of tissue breakdown. If there is indeed a concerning signal, a member of Podimetrics’ care team will work with the patient’s clinician to follow through on the most appropriate next steps.
10:00 to 22:00: Building a relationship with the VA
- 2011 was nothing like 2021: As the addressable patient population for Podimetrics is often financially challenged, it did not make as much sense to build a direct-to-consumer business model. Simultaneously, when Podimetrics was founded in 2011 there was substantially less willingness to invest in tech-enabled solutions for managing chronic care. This narrowed the customer set the company could initially engage.
- Fortunately, the company gained the interest of payers, for whom preventing even a single foot amputation would cover the cost of the SmartMat for many patients.
- An even stronger value proposition and partnership soon emerged with the Veteran’s Health Administration (VA)
- What makes the VA different: The VA is the nation’s largest integrated delivery network, where the provider and payer are one and the same. This aligns many incentives such that prevention and value-based care become not only good clinical decisions but also good financial ones. At the same time, according to a February 2021 report from the CDC, veterans also have a higher prevalence of multiple chronic conditions including diabetes. All these factors mean that the VA is well-poised to engage with solutions that can improve management of chronic conditions within a value-based setup.
- Getting started: Podimetrics’ foray into the VA began with a clinical trial at a number of VA medical centers. In addition to supporting the ultimate FDA approval of the SmartMat technology, this provided an opportunity for Podimetrics to work with VA clinicians early-on to build a community of champions around the product.
“[The VA clinicians] became huge champions of the technology as they saw firsthand what it could do. That allowed us to get a chance to start to commercialize it in the VA, and it has evolved now that we’re committed to ending amputations in the VA… It’s a wonderful opportunity for us to live our mission with an organization that is equally committed to the same goal.”
- The VA vs VC: While Podimetrics was undoubtedly successful working with the VA, Jon recognized that many companies have not been as fortunate. As such, venture capital may sometimes anticipate greater risk with organizations pursuing the VA as a key customer. To demonstrate that the VA can be a successful partner, Jon recommends building clinical support early and, to do so successfully, adapting to the processes that the VA may already have in place.
“I feel like every investor has been burned in the VA — they all have that story and they’re going to bring it up…. The VA is tough unless you can really get that grassroots clinician support, and if you don’t have it there’s no shortcut… A lot of startups will come into the VA and they’re not necessarily willing to change their model to the VA.”
22:00 to 32:00: Thoughts on the evolution of digital health in chronic care
- While it is encouraging that a growing number of companies are working to improve care for chronic conditions, this presents challenges as these same companies strive to compete with one another.
- Consolidation is likely to continue: In the last 12 months alone, there have been significant moves to consolidate in healthcare, from the Teladoc-Livongo merger in 2020 to the merger between Doctor on Demand and Grand Rounds announced earlier this month. Jon anticipates that this will continue to happen as companies hope to create more comprehensive and competitive solutions in the marketplace.
- Beyond mergers, bundling may also play a key role within chronic care. Particularly where customer strategies differ (e.g., B2B vs DTC), partnerships to bundle care solutions can become an increasingly viable way to “inherit” a commercial footprint without having to engage in the highly competitive bidding process.
“It’s almost like an efficiency play. You now don’t need the salesforce to go knock on all those doors, you inherit that with the deal… I think it’s becoming more and more viable for a lot of these DTC companies especially.”
- At the same time, Jon believes today’s willingness to partner within healthcare can enable companies that focus on simple yet important point solutions to succeed. Such companies may choose to pursue a strategy that intentionally depends on partnering with others to create a compelling packaged solution.
32:00 to end: Wrap-up and final thoughts for entrepreneurs
- 2020 was a record year for digital health investments. Jon expects capital to continue to be abundant in the near-term and encourages entrepreneurs to take advantage of this.
- He also encourages entrepreneurs to leverage diverse sources of talent. The pandemic has created new norms around remote working, and now more than ever it is possible to hire the best people for a role regardless of where they may be physically located.
Podimetrics is hiring! Interested candidates can check out their careers site at https://podimetrics.com/careers
