Sam Holliday & Dr. Sameer Berry, Oshi Health, on revolutionizing GI Care through a high-touch, integrated model

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Sam Holliday (left), Dr. Sameer Berry (right)

Our guests this episode are Dr. Sameer Berry and Sam Holliday, co-founders and CMO and CEO of Oshi Health. Oshi Health is a virtual gastrointestinal care clinic increasing access to care for the one in four Americans with digestive disorders. Oshi raised their series B of $30M in March 2023 and is backed by Bessemer Venture Partners, Flare Capital, CVS Health Ventures, Frist Cressey Ventures, Koch Disruptive Technologies, Takeda Digital Ventures, and two leading GI medical associations, the American College of Gastroenterology and the American Gastroenterology Association.

Oshi Health’s high touch model connects patients with an integrated team of GI providers, registered dieticians, GI specialized mental health clinicians, and care coordinators to identify and address the root cause of chronic digestive symptoms. Oshi serves as a preferred in network provider for many insurers and employer customers. The company also partners with community GI practices to provide their patients with access to specialized services, including dietary and behavioral therapies.

In this episode, I spoke with Sameer and Sam about:

• Oshi’s high-touch, integrated care model for GI patients
• Purpose-built clinical workflows to improve outcomes and cost savings
• Oshi’s partnerships with independent GI practices and health plans
• The future of virtual first specialty care

Rethinking a proven clinical approach that could not scale.

Oshi’s model is built on studies that show that multidisciplinary care leads to better clinical outcomes, better patient experiences, and lower costs of care for individuals with gastrointestinal disorders., This model was researched and pioneered over the past decade, including by William D. Chey, MD, FACG, Vice President of the American College of Gastroenterology, Chief of Gastroenterology and Hepatology at Michigan Medicine, and Sameer’s mentor during his GI Fellowship at the University of Michigan.

Sameer shared his experience at Michigan, seeing the benefits of an integrated care team but running into long wait times for patients to join the program. Telehealth allows a team to see more patients without losing the multidisciplinary approach and frequency of touchpoints needed to find and maintain the right treatment plans for each patient.

“This has all been proven, but how do we scale it brick and mortar delivery format? We can’t really scale that. We can scale, through telehealth, that multidisciplinary team approach but also the frequency of touch points that you need to find the right solutions, and then implement and sustain those solutions.”

Sam worked in diabetes prior to Oshi, following companies like Virta Health that were seeing lasting clinical results by using dietary changes and support between visits. When his mother and sister were diagnosed with gastrointestinal disorders, he saw how little support was available to most GI patients to make and sustain similar lifestyle changes.

“She [Sam’s mom] had a GI doctor tell her about low FODMAP, a complex diet to figure out on your own. The time that providers have to explain dietary interventions is limited. His solution was to give her a handout. She googled it and figured out how this dietary approach worked and her triggers then changed her recipes because she’s a trained cook. She then went back to her GI doctor and his mind was blown. He said to her, “Wow, you should start a company. Nobody ever figures this diet out.’ That was the first light bulb moment for me.”

Takeda Pharmaceuticals had been incubating a technological solution to support collaboration between IBD patients and GI physicians for better outcomes in partnership with Oshi’s third co-founder, Mike Goodman. After meeting, Mike, Sam, and Sameer decided to join forces. Oshi is now making the proven multidisciplinary approach available to the millions of Americans with GI disorders through virtual visits and other purpose-built technology for patients and providers.

“You can have a visit with the world’s best gastroenterologist, but if you don’t have the tools to implement the recommendations that we give you in an office visit, it can completely nullify that value… We looked at all the evidence and said ‘How can we get patients the care they need, and then give them the tools, technology, infrastructure and support to execute on those recommendations?’” — Dr. Sameer Berry

The need for GI support is driven by symptom severity not clinical acuity.

Oshi cares for all GI patients, regardless of their needs or clinical acuity. In Oshi’s clinical trial, the average participant attended 10 visits to achieve symptom control, with a range from 4–30 visits based on the patient’s case complexity. Sameer explained that, in GI, a patient’s symptoms lead to avoidable healthcare utilization. Regardless of their acuity level, if an individual is experiencing significant pain, they are likely to pursue repeated diagnostic testing and ER visits for answers.

“GI patients feel their condition almost every day, which is fairly unique. You don’t feel your High Blood Pressure, high cholesterol, or even your diabetes every day until things get out of control… We have to think about the acuity of the member’s condition not only in the traditional medical sense of the word… but also in terms of the patient’s perception of their acuity.” — Dr. Sameer Berry

Sam clarified that this is why claims data is not helpful to identify patients that need access to GI care. Instead of focusing on a subset of the population suffering, this is why Oshi’s health plan partners allow Oshi to see any patient without restrictions based on claims data or utilization history.

Flexing resources for each phase of the care journey

Sam shared that Oshi’s model is built to flex through the 3 phases of the care journey, adjusting the frequency of visits, remote monitoring, digital therapeutics, and synchronous versus asynchronous communication appropriately.

1. Assessment and Preliminary Diagnosis. Patients are introduced to Oshi through health plans, employers, and local provider referrals and can quickly book their first appointment online. On average, patients see an Oshi provider within 3–4 days. Oshi tracks down prior medical records before the first visit so the patient does not have to repeat their history. After the initial visits, there may be diagnostic testing.
2. Whole Person Therapy. Patients that need additional support enter the multidisciplinary model, meeting with dieticians, behavioral health providers, and their medical team ongoing to achieve symptom control. This includes symptom trigger identification and an iterative process to find the right tools to manage symptoms, whether that be medication, dietary changes, or cognitive techniques. Symptom control is the goal for Year 1.
3. An Ongoing Relationship. Patients that are maintaining symptom control stop regular visits, but can always return if symptoms flare up. Patients with more severe conditions that need ongoing medical management use Oshi as their medical home. Oshi providers continue to deliver care regularly, coordinating with local providers.

Building trust from the first visit

Oshi focuses on providing higher value care from visit one. As mentioned before, Oshi’s technology collects patient records before the onboarding visit. Sameer stressed how different this was from his experience working in a traditional care model where it is often easier to have a patient repeat labs or imaging than to find prior records. Additionally, Oshi’s initial visit is 45-minutes — protected time to listen to patients and build a relationship. Sameer explained that it is also a powerful tool to reduce costs as there is time to talk patients through why diagnostic tools or medications may not be right for them.

“We have our patient feedback integrated into Slack so we can see it come in in real time. I’ll read you one from this morning, ‘My first visit with Oshi was amazing. The GI provider listened to me and gave me such thoughtful feedback to an extent I’ve never received in my time traveling through health care. I’m very hopeful. I love Oshi’s model of care and I’m so excited to get started…’ When you start with an experience like that, you see why engagement follows.” — Sam Holliday

Quantifying the impact of multidisciplinary care and purpose-built workflows

We discussed the externally validated study presented at the Institute for Healthcare Improvement (IHI) showing that Oshi’s model resulted in significantly higher levels of patient engagement, satisfaction, and symptom control.

Results included 98% patient satisfaction, 89% of patients reported quality of life improvement, and 92% reported symptom improvement. Patients also reported 1.3 fewer missed workdays per month and a 64% reduction in avoidable GI-related emergency department visits. It also showed a $6,724 reduction in GI-related healthcare costs and a $10,292 reduction in all-cause healthcare costs per patient after 6 months in the program.

In addition to the onboarding process, Sameer highlighted several key driving factors for these results:

• Multidisciplinary Care: As mentioned, an integrated care team has been shown to achieve significant symptom improvement for GI patients. A study, published in The Lancet Gastroenterol & Hepatol journal, found that 84% of GI patients receiving multidisciplinary care found symptom improvement compared to 57% of patients receiving gastroenterologist-only care.
• Frequency of Visits: Oshi providers see patients every 2–3 weeks on average, allowing providers to order a limited number of diagnostics or therapeutics and then wait to see what works rather than ordering everything in one visit, reducing total costs of care.
• Culture around Care Delivery: For example, Sameer shared an Oshi protocol that requires providers to check for an upcoming imaging study before ordering an imaging study. If they have an upcoming study, the provider is expected to call the Radiologist to request that the second study be added, improving the patient’s experience and lowering costs.
• Patient Engagement through Education: Oshi chose longer appointment times to give clinicians the time to educate patients and give patients a place where they can come for answers. By educating patients on the pathophysiology of their conditions, they can better identify normal responses, reducing unnecessary ER visits.

“When you take the right clinicians and make them accessible to patients, that drives cost savings. It does not require any sort of incredibly complex technology. It’s really just structuring the way that we deliver care appropriately.” — Dr. Sameer Berry

• Provider Satisfaction: Clinicians work with an interdisciplinary team to meet the needs of their patients. The visibility of patient reviews also creates a rewarding positive feedback loop. Moreover, providers can creatively find ways to reduce costs and improve outcomes in their non-clinical time.

“All of us train to use all the incredible knowledge that we spent years and years and years acquiring, to give it to patients and to get the patients the care that they need quickly. When providers come to our model, they’re frankly just shocked… They’re shocked that they have this much time to spend with patients. They’re shocked that the patients have the resources that are available to them… You need happy clinicians to deliver high quality care.” — Dr. Sameer Berry

Working collaboratively not in competition with brick-and-mortar practices

Sameer addressed the growing pressure on independent GI practices, including a reduction in top GI reimbursement codes, increasing prior authorization requirements, rising personnel costs, a coming wave of retirement in the specialty, and an increased demand for care. A GI practice can refer patients to Oshi for a portion of their GI care, releasing some of the demand pressure and allowing the practice to focus on care best suited for brick-and-mortar and care that they are reimbursed for, including office visits, infusions, endoscopies, breath testing, and hospital consultations.

Oshi manages the multidisciplinary or high-touch services, including in-between visit touchpoints, that focus on avoidable utilization. When patients need in-person services, they are referred back to the practice. Long term, Sameer and Sam highlighted the opportunity for Oshi’s data and actuarial analysis capabilities to help GI practices execute accountable care contracts and other alternative payment models.

“We knew we had to build the core competency of working collaboratively with traditional brick and mortar care. In GI, there are significant in-person needs in many cases… There’s no way we could operate in this ecosystem independently.” — Dr. Sameer Berry

Transitioning to value-based care contracts and staying focused on GI symptoms

Oshi has been in a value-based care (VBC) program with Aetna for 18 months and recently completed its first full performance year, showing strong outcomes and quality utilization savings. The contract is a bundled payment model tied to historic data from GI patients that did not use Oshi services. Oshi is accountable for any utilization outside of Oshi, incentivizing providers to drive reductions in inappropriate ER visits, imaging, and procedures. After their first year, patients can continue to engage with Oshi on an episodic basis. More complex patients transition to full medical management. While the bundled payment stops after year 1, Oshi is still seeing an impact on cost of care in Year 2 and beyond.

While Oshi engages in VBC contracts, Sameer and Sam emphasized that Oshi does not serve as patients’ PCP. Oshi uses patient’s GI symptoms as their “North Star” and, therefore, does not treat depression, anxiety, weight loss, diabetes, PTSD, etc. Interventions are tailored to managing GI symptoms. For all other needs, Oshi Care Coordinators work to find the providers or benefits that the patient has access to through their employer or health plan. If they find gaps in coverage, they notify the plan to find care for the patient.

“It’s all a team sport, our goal is to get our members the care they need. Our number one core value is to do the right thing and get the patient what they need to get better so we invest in coordinating that care.” — Sam Holliday

Looking forward, Sam highlighted the increasing awareness of GI disorders in the employer and health plan market as the stigma around GI disorders has started to erode. Oshi is only serving commercially insured patients today with hopes to expand to more health plans and employers in the future.

“It’s akin to mental health five or six years ago. It wasn’t as well understood or as recognized as a major cost and had a lot of stigma. Thankfully, that has lifted and you’ve seen the mental health market really accelerated. I think Gi is going through the early part of that acceleration.” — Sam Holliday

Building workflows and technology to make collaboration easy

Sameer shared that Oshi requires the team to share notes and care summaries with patients’ referring gastroenterologists and primary care providers, and compensates its providers for 15-min referral calls with providers that Oshi refers patients to for care continuity. It also designed the appointment cadence to allow extra time for documentation and communication after each visit.

“Protecting your clinicians’ time throughout the day allows for that collaboration and relationship building… What really makes the relationship take off is when a patient goes back to their referring gastroenterologist or referring primary care doctor and says, ‘Wow, thank you for sending me to Oshi because that really helped me.’ That’s what builds rapport.” — Dr. Sameer Berry

Internally, Oshi clinicians have daily meetings to share learnings and discuss patients. Sameer and Sam also described the weekly High Utilizer meetings where the care team shares the clinical and social picture for patients with patterns of high unnecessary utilization and senior leadership allocates resources to help resolve complex treatment adherence barriers (ex. an in-home phlebotomist or directed behavioral health support).

“It allows us to really think creatively about what we need to do for a patient. If a patient comes in with abdominal pain, ordering every lab, stool test, imaging study, and an endoscopy doesn’t require much critical thinking… We deep dive to figure out, is it a health literacy issue? Is it a behavioral health issue? Is it a lack of trust with the healthcare system?… Maybe they always have pain on the weekends or evenings, and no one is available to help them through the process. We’ve had patients that have had seven endoscopies in the last two years. We make seemingly simple modifications to their care plan and their symptoms completely go away.” — Dr. Sameer Berry

Clearing the path to successfully scale virtual first specialty care

Sameer highlighted how COVID accelerated innovation in care delivery and forced the industry to rethink what could be performed virtually in coordination with in-person care. They expect to see the continued emergence of virtual first models, including direct to consumer, transactional, and complex coverage models.

Sam highlighted that regulations have been slow to evolve with telehealth capabilities and patient preferences, including:

• Clinician Licensure: While some states are forming compacts that allow clinicians to practice across various states, Oshi hopes that this transition accelerates so most clinicians be licensed across states more timely.
• Nurse Practitioner Scope of Practice: The allowed NP scope of practice and required physician oversight varies widely by state, limiting the rate at which virtual models like Oshi can expand to new states.
• Health Plan Provider Directories: To help patients find care, these directories are organized by zip code. There are nearly 30,000 zip codes in the US and virtual clinics are available state-wide on Day 1, making it harder for plans to notify patients of available care options.

“The history of healthcare until the last couple of years was defined by the local community — maybe there was travel to a center of excellence… That all changed with the pandemic. So much care can be delivered across state lines, but the regulation, payment models, and clinician licensure hasn’t changed.”

As virtual care expands, Oshi plans to stay focused on scaling its model to serve the millions of Americans suffering from GI disorders. The team plans to expand to all 50 states this year with the support of their partners. Sam described this as the foundation of their vision of being the most data driven GI clinic in the world.

As they expand data capabilities, the Oshi team hopes to open opportunities to work with researchers to measure the value and most appropriate use cases for new interventions, diagnostics, and therapies. As previously mentioned, Sameer and Sam also see the opportunity to use Oshi’s data and actuarial capabilities to help GI practices execute value-based payment models.

“There’s not a lot of value based care in subspecialties like GI, but we think it’s inevitable. We want to be a partner to all stakeholders, as that happens, to make it a win for everybody to move toward value.”

Sharing advice for MBA students and professionals building careers in digital health

“Make sure that you want to be in digital health…it’s incredibly complicated and highly regulated, but there’s a huge opportunity to do good and do well for yourself if you can kind of be part of the companies that are improving outcomes and costs here.” — Dr. Sameer Berry

“Master your craft. Technology is evolving so rapidly, and it’s easy to be replaced unless you truly have a deep understanding of an area. Someone once told me, you can become successful by either being the top 1% in one area, or being the top 10% in two areas… Find the thing you’re most passionate about within digital health and go deep.” — Dr. Sameer Berry

“Don’t view the job coming out of the MBA program as so defining… All those experiences become additive. The biggest thing I’d say is just be a sponge. Ask a lot of ‘Why?’ ‘Why does the company do this this way?’ Pay attention to the answers. Look at the way the company is led. Try to absorb both what works — what companies do well, but also where it doesn’t seem to work very well. Where there are problems and try to deeply understand why because it’ll help you develop as a leader.” — Sam Holliday

As Oshi Health continues to grow, there will be great opportunities to join the team. To see the roles that Oshi is currently hiring for, check out their careers site.

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