Transcript

The Advancements in Medical Technologies

[0:00] And it’s great that we have all the technologies we do. We have stents.
We have great open-heart surgery when we need it. We have aortic aneurysm stents, and we have pacemakers, and all these great devices, technologies, amazing developments.
But those are only useful after or when you have some major problem.

[0:20] Music.

Introduction to Prescription for Success Podcast

[0:25] Welcome to the Prescription for Success Podcast with your host, Dr. Randy Cook.

[0:32] Music.

Introduction and Welcome to Prescription for Success

[0:56] Hello everyone and welcome to Prescription for Success. I’m Dr. Randy Cook, your host for the podcast, which is a production of MD Coaches, providing leadership and executive coaching for physicians by physicians. To overcome burnout, transition your career, develop as a leader or or whatever your goal might be, visit MDCoaches on the web at MyMDCoaches.com because you’re.

[1:23] Not in this alone.
And don’t forget that CME credit is available when you listen with us.
Just look for CMFI in the show notes to learn how.
My guest today was recently named Chief Medical Officer of Actea, a Swiss medical startup which is in the process of disrupting the entire field of hypertension management with, a unique technology-enabled remote patient management platform.
The story of how he got there is a case study in moving from vision to reality.
So let’s hear my conversation with Dr. Jay Shah. I’m really excited today to be talking with Dr. Jay Shah, who is speaking to us from Boston today.
He has a really interesting story to tell about…
Some innovative additions to medical care technology, which I’m really excited to hear about.
So Jay, thank you so much for being here. I’m looking forward to the conversation.
Thanks very much for having me, Randy. It’s great to be on the show.
Well, let’s do what we always do, and that is talk a little bit about your origin story.
This part always fascinates me, how these remarkable people get the start and where they finally wind up.
Did you, I know you’re in Boston right now, did you grow up in the Northeast, or just where?
No, I did not I was born and raised in st. Louis, Missouri Wow Midwestern. Yeah, I’m a Midwesterner.

[2:51] Cardinals fan through and through.

[2:54] So but I’m we you know, like most of us in medicine or a lot of us moved around quite a bit for, Education and training so. Mm-hmm. Where were the medical influencers in your life at that time?
Where did that come from first would be my dad?
He was the first and only physician in our family. And he was immigrated to the US in the 70s from India.
The reason we ended up in St. Louis was, think late 1970s, immigrant physician arriving to the United States with no money and no resources.
You basically go where you can find a job.
Exactly. And so after some time finishing training in the New York area, he found his fellowship at Washington University in St. Louis. And then he ended up settling there right after training. He found a job with somebody he knew and that was it. And that’s how we ended up in St. Louis. Yeah, that’s a great story, I’m sure. Maybe we should get him on the show.

[3:55] But did you, this idea of following in your dad’s footsteps, was that something that developed earlier or was it later on? When did that come about?
Yeah, I mean, it started developing, I would say, you know, around eight or nine, you know, he would go to the hospital where he worked a lot to support our family.
Sure. And that was the primary way of making income. And so, he worked a lot. He worked nights, he worked weekends, he did on-call, he did sort of locum’s work, wherever he could find it in in addition to his practice.
And so I still remember to this day, we would go sometimes at night to the hospital, and he’d round on some patients or read some ultrasounds.
And one of the hospitals, Washington University Barnes, had this huge building of offices and these extremely long hallways.
And as an eight-year-old, that’s what I remember the clearest, which is just running down the hallways with my brother at full speed at 10 PM at night, or 8 PM, whatever time it was.
That was my first exposure to being in a hospital or being in medicine, was those kind of activities.
Or sitting in the nurse’s station, and they’d always give us lollipops or whatever, so hanging around when they see kids and stuff. So yeah, that was how I got exposed.

[5:15] So you were familiar with the environment. Was there anything in particular that you can think of during those really early years that caught your attention and held your interest?
Yeah, I think mostly, you know, my dad practiced community practice and his patients really, he liked a lot of aspects of medicine, but what I remember the most and connected with the most was just getting to know people, getting to know his patients as people, as families, as individuals, and for them to know him and through him, our family.
And that was, I guess, for me, what drew me towards medicine more than anything else, more than science, more than biology, although I enjoyed those things, that’s not really what drew me to it.
It was the people and the experiences and relationships.
Yeah, so it sounds like that your dad was very happy in his role.
Is that a good read there? He really enjoyed medicine and practicing medicine.
I think if he could, he would still do it today.

[6:17] He retired a few years ago and I think he wishes he probably could keep up with all the advances and technology and electronic health records and stuff, which really kind of made him, in his generation, difficult to keep up with those things.
But I think overall, if he could still practice, I think he would too.

[6:37] Yeah, well, that’s bound to have been a really positive influence on you.
And so you decided to go to medical school right there in your home territory, right?
I did. I ended up in medical school at this, well, sort of different at the time, it was a combined bachelor’s and medical degree at the University of Missouri in Kansas City, so it’s just- It was innovative way back then, wasn’t it?
Yeah, it was. And it was one of the first schools to do that.
And it was quite a unique and innovative curriculum that they had developed.
Forward-thinking for, you know, for the lack of notoriety that the school had. A lot of those concepts that they pioneered in the 70s and 80s are being implemented today. Patient-centered approach, physical exams starting in year one of the program, immediately immersed in patient care, teaching curriculum not by academic subject but by disease state. All of those things that were, they They were quite innovative in that regard.
Hi, I’m Rhonda Crowe, founder and CEO for MD Coaches.
Here on Rx for Success, we interview a lot of great medical professionals on how they grew their careers, how they overcame challenges, and how they handle day-to-day work.

[7:53] I really hope you’re getting a lot of great information, but if you’re looking for an answer to a specific problem, management or administration challenge, or if you’re feeling just a bit burnt out, like maybe you chose the wrong career, well, then there’s a faster way to get the help you need.
No, it’s not counseling. It’s coaching.
Rx for Success is produced by MD Coaches, a team of physicians who have been where you are. I know you’re used to going it alone, but you don’t have to.
Get the support you need today. Visit us at MyMDCoaches.com to schedule your complimentary consultation.
Again, that’s MyMDCoaches.com.
Because you’re not in this alone.

Introducing Physician Outlook: A Magazine for Physicians

[8:40] We’ll get back to our interview in just a moment, but right now I want to tell you a little bit about physician outlook, If you haven’t discovered this remarkable magazine, please do so very soon, It was created by physicians for physicians to showcase the intersection between clinical and non-clinical clinical interests. Whether it’s writing, painting, cooking, politics, and dozens of other topics, Physician Outlook gives a physician perspective. It’s available online and in print. It’s really unique among physician lifestyle magazines. And like the Prescription for Success podcast, Physician Outlook amplifies the voice of any physician who has something to say.
It also engages patients who still believe in physician-led team-based care.
And Prescription for Success listeners can get three months free when you enter our promo code RX4Success and select the monthly option at checkout.
That’s a really great deal on this stunning publication.
And now let’s get back to today’s interview.

[9:49] So, at what point did you begin to give some thought to what your long-term career was going to look like? When did the interest in cardiology make its appearance?
Again, influenced by the people that we come into contact with, I think in medicine is probably the most important driving factor, oftentimes, with what people decide to do. So, you know, my strongest influence, two influences. My father is a cardiologist and my Dr. Woodridge is a primary care internal medicine physician. So I said, well, I definitely think internal medicine is the way to go and gives me a lot of optionality and I might end up doing cardiology. So that’s how I decided to just do internal medicine and make that decision in medical school.
And then with a view towards perhaps cardiology, perhaps other things, endocrinology, I really enjoyed. I even thought about anesthesiology after. There’s a lot of things, but cardiology has probably stayed a primary in my thought process.
Dr. Darrell Bock Actually. And then when it came time for postgraduate training, and I’m really interested to hear some more about this, you got yourself.

[10:58] Lined up at Mass General, which had to have been one gigantic cultural shift, if not culture shock, for you. So I’m interested in how that became your pick and what the experience was like.

Cultural Shock: Transition to Mass General

[11:12] Well, you nailed it there, Randy. It was a gigantic shift for me. I was a Midwestern kid, you know. I grew up in St. Louis. I’d been to the East Coast and West Coast just from traveling, but never really imagined myself living there. Very few people from University of Missouri in Kansas the city ever got the opportunity to go to one of those institutions at that time.
I think that has changed over the years, but at that time. And yeah, one of the things that I did very definitely was really, really work my tail off in medical school.
With the hopes and view of getting to one of these other programs like a Mass General or Hopkins or, Yale or so on Mm-hmm, and I had no idea what they were like I had none. I had no clue.

[12:01] It’s that it’s that youthful exuberance that take you have no idea where you’re going right? No idea where I was going I had no idea what I was gonna do there. I had no clue what it was like I did some external rotations, a great one at Emory.
I did one at Columbia, but never even ended up in Boston.
To the point where when I applied for residency interviews, and I got a number of them, thankfully.
I actually had to decline some because there was too much time and I didn’t have enough resources, honestly, to fly to all these places.
And it was a lot of time committed to trying to travel to all these places.
So I picked based on city, as it were.
So I said, well, I’ll take one in Boston. I’ll take one in New York.
I’ll take one in San Francisco.
And so I just picked whatever option came my way.
And so in Boston, I got an option to go to Mass General, or interview, and an option to go to Brigham.
I actually still, to this day, I don’t know why, I’ve declined the Brigham and Women’s interview.
Because I didn’t know.
I just said, I can’t go twice. Are you out of your mind?
It’s like $500 to go there, which is, at the time, seemed like a lot of money.
And I was like, I’m not going twice. I’ll go once, and I’ll pick Mass General.
And based on no realistic underlying thought process other than that.
And so that’s how I decided. And anyway, then when I went for the interview.

Different Attitudes and Perspectives at Mass General

[13:28] Boy, that’s when I realized that, whoa, this is a different place.
This is a different type of institution than I had ever been exposed to.
Can you just name a thing or two that kind of stood out the most?
Yeah, once I got there, not in the interview, but once they gave me the spot and I matched, went through the match, and within the first few weeks or month, I could just tell.
I mean, the people that were my peers were so vastly different than anyone I’d ever met in medicine.
Meaning, one of my peers in residency, same class, had developed a new molecule and sold it to the government of Singapore.
Another person…

[14:09] Had come from Africa after running a NGO for the WHO for the last five years.
Another one had come from the White House after having just finished a White House fellowship and public policy degree.
And you could tell they were just on a different wavelength, different attitude, and approach towards medicine in general, that medicine was their grounding to something else, whether it be in drug development, or public policy, or education, or research, whatever it is.
But the attitudes and the view of the people are so dramatically different.
It really opened my eyes to a completely different way of thinking about what you can do with a career in medicine.
Yeah, and I want to hear some more about that. It sounds to me like you were truly spellbound by the experiences and the level of education of people that were around you, do you think that your ideas for what your future would.

[15:13] Be like changed in any way right at that point?
Or am I taking this too far? Dr. McGill I don’t know that it changed right then and there. It definitely opened some doors in my mind that had never been opened, just to the idea of doing many other different things other than practicing medicine.
And I will say that despite those experiences not being there at University of Missouri in Kansas City, one of the things that I was the most advanced at, in comparison to these really phenomenal people at Mass General, was clinical care delivery, actually taking care of patients.
I had the most experience out of probably most of them, if not all.
And so it was a very odd sort of disparity where on the wards, in clinical care, I was as comfortable as anyone there, if not more so.
But when it came to things outside of clinical care delivery, I was a novice compared to the majority of them.
And so what it really did was expand that side of my brain and that side of my potential in my mind that, you know what?
I can be really good at practicing medicine, but look, there’s so many other things that I could possibly do.
I think it put the seeds in my brain, although I didn’t make any other significant career decisions while at my time at Mass General.
Well, I can certainly see how that would have had an impact on how you happened to wind up where you are, which of course we’re going to get into that in some more detail.

[16:40] But in any case, uh, at.

[16:44] At the end of your internal medicine training, and you made the decision to get back closer to your home turf. Can you tell us how that came about?

From Mass General to Washington University in St. Louis

[16:53] Yeah, that came about, so I had made the decision to do cardiology, and at the other major thing, life event that happened at Mass General, that’s where I met my wife.
And she was also an internal medicine resident, and she was applying for a fellowship as well around the same time.
So one of the complexities of having, as many of us know, who have spouse or partner in medicine, is that you very rarely are making decisions just for yourself.
You have to make decisions for both of you and what can work for both of you.
So we ended up at Washington University because it had a significant, it was large enough to accommodate two fellows around the same time that they made those accommodations.
We were also, again, lucky enough that it is a tremendous clinical powerhouse, research powerhouse. And just to make sure that our audience is up with the geography, we’re talking about Washington University in St. Louis.
In St. Louis, yes. This is Washington University in St. Louis.
You know, it’s a 1,200 bed hospital with a catchment area of probably 10 states.

[18:00] And it’s one of the biggest medical centers in the country. Although, you know, I think it gets less notoriety just because it’s in the Midwest.
But a fantastic place to be a fellow and to really, really get strong, super strong clinical experience.
And so we had, you know, it was an enjoyable three years there as a fellow.
And once you got to that point, now everybody is fully qualified to do what they set out to do.

[18:27] Now you’re gonna try the other coast.
How did that decision come about?
Yeah, so this was interesting. You know, it’s funny how these are all life circumstances.
This was 2012, so about three years after the start of the Great Recession.
Country still really hadn’t recovered at that point.
The Affordable Care Act had yet to go into effect.
So, physicians were not retiring because of their financial situation.
They were also, hospitals and clinics were not hiring because everyone was unsure of what the Affordable Care Act was going to do to them.
And so, it was actually an exceedingly difficult time to find a clinical job in practice.
And there was two of us, so that made it even more difficult.
We ended up looking a lot of places, you know, applying a lot of places, and one of them that we got an opportunity for both of us was in Portland, Oregon.
And we decided, you know, at this point we didn’t have kids, we wanted to try the West Coast.

Moving to Portland for a new cardiology practice

[19:21] We never lived there and thought it would be interesting and fun. And so we did.
And so it was, that was the impetus really to move to Portland.
So this was an established cardiology practice that was ready to take on two additional partners?
No, no. My wife was, she got a position full-time with the academic university. I see.
My position was different, that this was a very odd thing to do after fellowship in retrospect.
Although I didn’t quite see it at that time, it’s the same way.
But basically, it’s to start your own practice. I started my own practice in Portland, in the middle of metropolitan Portland, under the umbrella of a multi-specialty group, but there’s no cardiologist.
And so I essentially put out a shingle and a couple EKG machines, a really great medical assistant, and that’s it.
Went to work, building a practice from scratch.
Yeah, that was my primary first job out of training. Well, that gives me some idea about what the demands for cardiologists must have been like at that point.
Yeah, there’s always demand. I mean, it’s a referral practice, cardiology is.
And typically you’re dependent upon primary care providers.

[20:39] Providers to support your patient population, and clearly they needed some additional cardiologists, and obviously you were more than- I don’t know that, yeah, it was not, I would say looking back on it, it was definitely the first few years were not easy.
You know, I had never done that before, and my competitors were four gigantic employed cardiology groups.
Those are my competitors. There was really no other significant private cardiology group in town.
So it was kind of an odd thing, but what I found, which is what you’re alluding to, Randy, is that there’s plenty of demand. There were plenty of cardiologists in Portland.
It’s not like it was an underserved area.

Creating a patient-friendly experience as a key differentiator

[21:25] But what I found was I had an ability, and there was also a clear niche, of setting up a practice that was so friendly towards patients and so easy to navigate as compared to large.

[21:38] More bureaucratic, larger, employed groups, that patients would come, and once we were able to demonstrate that our service was better, not medical service, that’s not what I’m talking about, quality.
I’m talking about just what’s termed in the tech world, what’s the user interface?

[21:58] What is their interface with the medical office? We were able to develop and design an interface that was so easy to use for patients, That is why they came, and that is why they stayed, and that is why they brought their brothers and sisters and mothers and fathers.
We didn’t have the technology. We didn’t have a shiny building.
We didn’t have great contracts. We didn’t have all the bells and whistles of a major hospital, but patients would come to see us because it was a better experience for them.
Dr. Darrell Bock Yeah, so you had the opportunity to think about what makes life better for the patients when they come through your door as opposed to having that decision made by some far-removed corporate executive.
And it seems to have paid off. You would think the corporate executives would look around and do things differently, wouldn’t you?
Well, when was the last time you went to the doctor’s office?
I went myself last week.
And I tell you, Randy, I mean, it is.
And this was a major Boston Medical Center, OK, major.

[23:02] It is shocking. I mean, it still shocks me. Every time I walk in, I’m like, how clunky is the system, how cumbersome does it have to be? How many times do I need to fill out the same forms with the same information?
How many times do I need to be asked the same questions?
I mean, it is really cumbersome. I think probably you and I understand that the reason why that happens is because no physician would ever design a patient experience.

[23:30] To occur in that way.
Correct.
But when the providers are the tools of a corporate structure, a lot of that ability to change what happens at the patient interface is taken away from the physician, in my experience.
And I don’t think it’s a good thing. I’d be happy for you to react to that, rather than let me preach here. But that’s kind of the way I see it. What do you think?
I think that that is a.

[24:01] A very likely possibility. I think that if you look at physician-owned or physician-led organizations, they don’t have to be physician-owned, but physician-led organizations, oftentimes the quality metrics are better. Oftentimes the experience maybe is slightly better. But I also think that just in general, the idea of the, you know, I’m going to say it.

[24:25] But we don’t usually use this term, but the idea of a customer experience is not generally thought of as primary or central, to delivery of healthcare.
And I think physicians are part of that too. You know, we think about quality in terms of bad outcomes, or we think about complications or rehospitalization, all the very important things.
And we see patient satisfaction scores as a primary metric of, quote unquote, the customer experience.
But that’s not really the same thing.
And I think we could, as a collective, and I certainly am trying to do this in a lot of ways, both in practice, but also in business. But taking the idea of the patient and saying, well, what if I was that consumer of health care?

Reframing healthcare from a retail perspective

[25:09] What would an ideal journey through that user experience be?
And clearly, it’s not what we have.
So I think reframing it sometimes in that perspective and approaching it not from a scientific or academic way, but from a retail experience.
There is a difference when you walk into a major electronics supplier store and a difference when you walk into Apple. And it has to do with the customer experience.
How are things set up?
And how easy is it? And how flexible is it?
And how clean does it look?

[25:45] And do you want to be there?
Nobody really wants to be at the doctor’s office, generally.
But can we make a design and experience that makes it better, makes it more friendly, makes it easier? And that’s what we did within our budget and constraints in Portland.
But I think that there’s a clear opportunity for organizations as they try to be a differentiator in the markets that they serve.
That is one, I think, largely ignored area, is what is their customer experience?
Yeah, I couldn’t agree with you more. And the interesting thing to me is that many of these customer satisfaction metric scoring systems and the decisions that flow from them are put together by people who never touch a patient.
My own prejudice is that they really should leave that to the doctors.
And it sounds like maybe you agree with me on that.
Am I getting it right? I think so. I mean, I think the physicians have to be stronger in terms of their leadership there.
And I think that’s one thing, as you said, that has largely been shifted towards administration and others that don’t directly care for patients usually.
And I think physicians need to take a stronger role and lead with a stronger voice, but also have that mindset of what is that user experience like, not just from a scientific angle, but from a real consumer angle.

[27:09] I’m interested to know, it seems to me, as I look at your biographical information, and you can correct me if I’m wrong here, but there seems to be a point of evolution with your respect toward how to manage patients.

Seeking Change and Growth in Cardiology Practice

[27:28] With chronic ongoing illnesses, particularly hypertension. What kind of led me to this journey that kind of where I am today is that, After practicing in Oregon for seven years.

[27:44] And then Mayo Clinic for three plus years, you know, I’d been doing really high level complex cardiology, and it was great.
And I had become very good at it.
And my patients really liked me. I enjoyed what I was doing in terms of clinical practice.
I felt a sense of mastery, you know, after 12 years of practice.
But what started to kind of make me think about other things was that I was kind of doing the same thing in a routine.
And what I really enjoyed about my practice in Oregon was the building process, was change, was improvement.
And I felt a sense of stagnation for myself, personally and professionally.
And so I started thinking about, well, what else could I do with this experience, with 12-plus years plus all my training, what else could I do? How else could I?

[28:42] Be of value to people, health care, but do it in a different way where it’s not so routine or where it’s not so, you know, one patient at a time all the time, day in and day out. And how could I have a bigger impact? And that’s what led me down a fairly lengthy exploration of what else is out there. Now thinking back to all my colleagues at Mass General and saying, okay, where did they end, up. And so I started this process of what are the possibilities out there for physicians like myself.

[29:14] Fully clinical for a long period of time, you know, not a researcher, but not doing clinical work. And so I started this process and it took me a good 18 months and, you know, included over 100 informational interviews with people, you know, just starting to think about, okay, what What does the chief medical officer of MasterCard do?
I don’t know.
I haven’t called them. What does the chief medical officer for New Core Steel do?
Or Rio Tinto, or whatever.
I mean, what do these people do? What do people do when it means they’re in pharmacovigilance for a pharmaceutical company, or drug development, or clinical? What are those things?
And so I talked to over 100 physicians doing these different careers.
And I started, what was most important about that process was honestly was crossing things off the list.
You know, I think, oh, this job sounds really cool. And then you talk to them and you figure out.

[30:09] What they actually do and you’re, and I thought, okay, yeah, that’s not for me.
Yeah, I don’t think I’d like that, or I’m not qualified, or this is really not something I, you know, would even want to try.
So that was really helpful. So I ended up figuring out that, okay, I need to stay within some domain expertise of cardiology or cardiology related.
And smaller companies, I think, sounded to me better than, you know, really large companies for the same reasons that I like Portland Clinic. Able, small, able to build, able to change faster.
And so I ended up finding this Swiss startup that really wanted to make some innovative changes to how we look at and treat blood pressure.
And that fit really well, because for over 15 years, I’d been taking care of the end effects of high blood pressure, heart attacks, stroke, kidney problems, aneurysms.
And so this kind of flipped it on its head and said, well, why don’t we try to prevent some of these things?
A lot of very effective self-examination at that point for you and a rarity, I think, amongst humans in general.

Development of the idea and technology behind Actea

[31:22] But can you just go ahead and talk about where the idea came from and how it developed with respect to instead of getting blood pressure checked in the physician’s office once a year and adjusting medications to actually watching it on a day-by-day, moment-to-moment basis.
Well, it long predated my arrival into the company. The founders are Swiss and have been working on this technology for over 20 years.
They’re biomedical engineers.

[31:54] Their life’s work has been on how to take optical signals from LED lights and optical sensors and turn them into physiologic parameters.
So they did really some of the seminal work on delivering heart rate from green LED lights way back in 2003-4. So this was well before an iPhone, smartwatch, any of these things.
And so many of their discoveries as regards to heart rate are still used in all these technologies that we have today.
They took that experience and said, what else can we do with it?
Can we really determine blood pressure from the same, or at least similar, sensor technology?
And that’s what started an 18-year journey of first animal models and trials for physiology, then human development, and then eventually getting to a working prototype that was able to be validated and tested. And so that’s how they arrived at the technological innovation.

[32:55] And then as a physician, certainly as a cardiologist, or any real physician who who takes care of patients for the long-term, we all know that…

[33:05] Inherently, it’s not one blood pressure at one point in time is not really reflective of someone’s long-term risk from high blood pressure.
It’s really how consistently is that person in an optimal range that determines do they, you know, will they have effects from that high blood pressure or blood pressure-driven diseases like heart attacks, stroke, aneurysms, you know, kidney disease, erectile dysfunction, even pregnancy-related.
It’s all those, those things are all time related.
So it makes conceptual sense to say looking at blood pressure not in terms of one snapshot at one point in time, which is what a traditional cuff gives you, but let’s look at blood pressure as a trend over months, years, decades.
The best corollary or analogy to this would be the development of continuous glucose monitors or CGMs for diabetes and have going from a one-time finger stick glucose check to looking.

[34:07] At trends and patterns over long periods of time.
Dr. Darrell Bock And did they find you or did you find them?
Dr. Jim Krosnick Both, honestly.
I didn’t know them and they didn’t know me, but I was ready after that 18-month process. I was getting tired.
It was about November and I was getting tired of interviewing and applying and getting declined her nose. And so I was ready to give up. I said, let me put this on pause for the holiday season, because it takes a lot of energy and effort. But I saw it the last day. I just looked scrolling through LinkedIn. I saw this thing. It said, cardiologist for hypertension knowledge. I said, OK, that’s me. OK, throw it. Here’s my application. Not really expecting much from it and not knowing who Actea was. And that was it. They called me back, emailed me back right away, and went through through a short interview, three, four week process.

[34:56] And done deal.
Can you give us a fairly short summary of where Actea stands as a product in the marketplace right now?

Actea’s current market presence and challenges in the healthcare system

[35:07] Are we gonna, or people like me, the bazillions of us gonna be wearing these things soon?
I hope so. But I think that we are in the European market. We’re in the EU, UK.
We have approvals in Canada and Australia. It is a regulated class two medical device, so you have to go through all the regulatory.
Processes. And so we have about 50,000 active users in our current markets and across Europe.
We are actively engaged with the FDA. I cannot give you probably a good estimate on timing, but.

[35:42] You know, we hope by the end of next year to be at least have an approval or, you know, likely approval. So it’s still a good fair bit away from the U.S. market, I think, but that’s the process it takes and that’s the time it takes to get approval. But we’re having great traction in the markets we are in, so we’re going to keep going.
Well, I think it’s very exciting, and I’m sure you’re excited about it.
I practiced medicine myself in excess of a half century, and I am aware of the sort of futility of checking a person’s blood pressure in a doctor’s office once a year and prescribing medicine and really thinking that we know what we, with that plan, how can you possibly have any idea whether or not you’re having any effect or not, not even to speak of the long-term or downstream and secondary effects of hypertension.
So I should think that this thing would really be taking the world by storm, at least that’s the way I see it, or are you, is the company seeing that kind of interest?
I think when I speak to physicians and we describe what it does and how it does it, they all mirror your enthusiasm.
Where the challenges are…

[37:09] Is not really in acceptance of that there’s a better way to look at blood pressure, but the challenges are that the alignment for the healthcare systems in the U.S. and most of the world is very much against preventive and…
Yeah, it’s disease care and not healthcare.
Correct, correct. So, you know, as a cardiologist, I mean, who best to understand this, but, I do better, and all cardiologists, and if people are sicker.
There’s no way to say it other than that, you know? And that’s how…
And it’s great that we have all the technologies we do.
We have stents, we have, you know, great open heart surgery when we need it.
We have aortic aneurysm stents, and we have pacemakers, and all these great devices, technologies, amazing developments.
But those are only useful after or when you have some major problem.
Yeah, the damage is done. Right.

[38:03] So statistics are aligned with this. I mean, 75% of US health care dollars are spent on the end effects of some chronic disease.
3% are spent on preventive management. So of course, the system is solving for exactly what it’s designed to solve for, which is disease-related care, episodic care.
And so that is the primary challenge when you start talking about a device software that costs a little bit more than a traditional cuff.
And to go and say, well, you can do this better, physicians like yourself, like myself, will say, oh, yes, we agree. We can do this better. There’s no doubt about it.

[38:48] But the question always is, well, who’s going to pay for it?
Because insurance don’t pay for it.
Hospitals don’t want to pay for it.
Physicians aren’t going to pay for it.
Well, if I were an insurance company, I would be a big investor, and I’d be giving it out for free.
Well, you’d think that, right? And I thought that, too.
But you know, one of the surprising and disheartening things I have learned in doing this is that the churn rate on insurance plans, private insurance, meaning the time it takes for one person to go from one plan to a different insurance company, is less than three years.
So if you cannot show to the insurance company a return on investment in less than three years, it’s a hard sell.
And so they’re not willing to pay for it in that regard. But you have to show that within a very short period of time.

[39:42] And that’s how you can win that argument. But otherwise.
They don’t, you know, they’re publicly traded, quarterly earnings mean everything.
That’s the reality of it. That’s the thing I always overlook.
And it is, in the end, all about the money. That’s not likely to change.
So, well, I didn’t really mean to bring us to a close here on sort of a somber note there.
I would like to say, I would like to emphasize what a brilliant idea this is.
And I am confident that it’s just a matter of time before somebody figures out a way to underscore the fact.

[40:23] That this is bound to be financially a good thing for all of us, the businesses and the consumers alike.
And I know that you have got to be incredibly excited to be involved in the process.
So congratulations to you for that.

[40:42] Yeah, thank you. Thank you very much. No, I’m equally excited.
And just to kind of finish this note about what we were talking about, I first got discouraged when I first started this role.
And I was talking to these insurers and other hospital systems.
I was running into these roadblocks.
But I think what it’s made me realize is that for an innovative or for something new, and you’re trying to find the market, and you see there’s clear value to patients, and I feel frustrated sometimes when people won’t put value behind that in their own regard.
But that doesn’t mean that it should fold up. It doesn’t mean you should give up.
And the process of innovation in health care is exceedingly difficult.
And there’s a reason for that.
And these roadblocks are the reasons. And so you have to find the people who are going to be early adopters.
You’ve got to go get them and feel encouraged by the wins that you do get.
And I think there are plenty of people in the world who realize the value of preventive care.
There are plenty of people who realize the value of putting value on preventing the effects of chronic disease.
But you’ve got to just go find them. And they’re not necessarily the groups, organizations, or people that you would first think about.
And that’s OK.
So go find the people who are willing. Go find the coalition of the willing and build it.

The Power of Taking Risks and Embracing Uncertainty

[42:08] And the others will follow once they see how valuable it is.
Well, that is exactly the optimistic note that I was looking for.
And I appreciate you sharing your story with us and for bringing us to that point of optimism.
I think what we’ll do at this point, Jay is getting me out of the way, and I’m going to close my mic and let you speak to the audience on your own.
So, audience, this is Dr. Jay Shah to share his personal prescriptions for success.
Thanks, Randy. I would say I have, you know, there’s three things I would say, one, take more risk.
Two, work for yourself. And three, embrace uncertainty. And if I had to go through those, I think the first taking risk is, in different ways than my experience, are the only times, not the only, but the primary times when I’ve really learned something about myself, or learned that I surprised myself that I could do something that I didn’t think I could, or something I thought was going to be successful wasn’t, but the only time I figured those things out is when I took some risk.
And if I had to tell myself, my younger self, to do something different, I would say take even more risk. Try things that are…

[43:26] Even more uncomfortable. Second is work for myself or work for yourself. And I don’t mean this as working by yourself, but what I mean is in my mind, especially after being blessed with a family, is that the reasons to do things and leave my family, leave the house, go away and work in some capacity for whatever reason, whether it’s for an organization or for my own practice, is, it has to be worth it.
There has to be enough trade-off to me to say that, yes, it’s worth leaving my child, my baby, my spouse, my partner, and giving my time to something else, because there’s a trade-off.
There’s something about that work that is of significant enough value to me, and it can’t always be money.
Sometimes it is, but it can’t always be money.

[44:17] So work for yourself in that regard. And realize, I think a corollary to that would be realized that compensation comes in many other forms other than money.
And the third thing is embrace uncertainty, meaning that I always had gone down this pathway, medicine tends to do this for us, where your next several years are planned out.
You’re going to medical school, and then your residency, then fellowship, then you’re going to practice, and then it’s just laid out for you.
And it’s secure, it’s certain, you don’t have to make a lot of decisions to do that, but It also, I think, tends to give us track mindset, and it doesn’t allow you to develop or grow in ways that you may not be aware of, in ways that maybe really take you down a rewarding pathway that you, without taking some risk and embracing uncertainty, you would have never gone down.
And I think that that’s where this journey, in the last few years for me, last five years or so, has really led me to this point where I feel like.

[45:19] That is, if you can embrace it and feel comfortable in the uncertainty, comfortable in the unknown, for me at least, that’s been a good spot to be in.
And those are my three prescriptions for success.

Embracing Uncertainty: A Key to Success

[45:32] That’s a very good list.
So be willing to take some risk, work for yourself and find some value in what you do.
And embracing uncertainty, boy, that last one is tough, but clearly it has paid off for you.
So much for sharing the story with us today, Jay. Before we go, I want to give you an opportunity to share with our audience where you can be found with email addresses or websites or whatever you would like to share.
Well, first of all, thank you for the candid conversation, Randy, and for having me on the show.
You can find Actea at all social networks at at Actea Global.
Our website is www.aktia.com, A-K-T-I-I-A.com, and you can connect with me personally on LinkedIn is the best way to do that.
Well, once again, thank you so much for being here. This has really been a fascinating conversation.
I have enjoyed every minute of it, and I am grateful that you were willing.

Thanking the listeners and inviting reviews and ratings.

[46:35] To take the opportunity to be with us. Thanks a lot. Thank you again, Randy.
My pleasure. Thank you so much for listening with us today.
If you enjoyed the show, you can help us reach more listeners by leaving a rating and a review, especially on Spotify or Apple Podcasts.
And if your app doesn’t have that option, leave us a voicemail through SpeakPipe at, www.rx4successpodcast.com.
You can also help by becoming a Patreon member.
That link is in the show notes. And we hope you’ll also follow our companion podcast, Life-Changing Moments with Dr. Dale Waxman.
Special thanks to our producer, Craig Clausen, our promotions manager, Mariana Rodabaugh, and to Ryan Jones, who created and performs our theme music.
And remember, be sure to fill your prescription for success with my next episode.

[47:29] Music.