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This is Eddie Qureshi, founder and CEO at Rainfall Health, and the host of this
podcast.
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Today on the podcast, we have Patrick Sheehan.
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He's a healthcare leader at the intersection of technology and care delivery focused
on virtual and at-home services for people with chronic conditions.
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As VP of value-based care at Withings Health Solutions, he partners with
risk-bearing organizations to design and scale programs that improve affordability,
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outcomes, and the care experience.
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His recent work with Withings includes MedStar Health to bring connected devices
into the concierge primary care and Withings' acceptance into the CMS ACCESS model
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for technology-enabled chronic care for Medicare beneficiaries.
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Right now, we're gonna dive into everything CMS, everything Withings, but let's just
start off with you, Patrick, which is what got you interested
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in value-based care and
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risk bearing organizations of all things.
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Yeah, and first off, thank you, Eddie and the team for having myself join this
podcast.
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I am a huge fan of what you're doing at Rainfall as well.
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The community in the value-based care is, I think, of greatest joys of playing in
the value-based care arena is the community of all of us trying to make life better
for
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patients.
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I got into this space
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Early on, when we look at the Affordable Care Act in the early 2010s, I had the
privileged opportunity to be at Dartmouth during that period, and Dartmouth was one
of
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the policy hubs for this accountable care organization.
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And it really inspired me about what could be in healthcare by better aligning
incentives and spurring innovation towards a better healthcare system for all.
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And that's led me down a very exciting path, initially at a Medicaid ACO, but then
around the turn of early 2010s, late 2010s, early 2020s, late 2010s, I started
working with
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virtual care companies.
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And the idea of delivering care virtually was not only feasible, but seemed also
impactful.
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And that's now led me to Withings in the work that we're doing here.
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You know, Withings has a long history.
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I'm sure we'll get into it, Eddie, but I believe that technology is the greatest
enabler of value-based care, and I'm most excited today about what AI can do to, you
know,
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accelerate what is now more of a stagnant value-based care movement overall.
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I couldn't agree with you more about value based care and as a entire market sector
and the people who help prop it up
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and technology which helps us scale it.
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I couldn't agree more, Patrick.
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But for people who are a little bit less familiar with Withings, tell us what do you
all do and how do you do it?
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Yeah, absolutely.
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So, Withings is a very interesting history that starts with the idea in 2008, 2009,
the idea of stepping on a device at home and that device's recordings, the
biomarkers, coming
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back in a digital format on a smartphone.
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And that basic, simple idea was the first time that happened.
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And that set off a long course of innovation.
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where we've layered in other value propositions over the last 16, 17 years.
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So what started off as a device ecosystem, and today we do weight scales, blood
pressure monitor, urine analysis, a number of devices.
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Now we are also providing data intelligence.
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So whether we're doing remote monitoring with health system partners, or we're
providing more insight to our consumers.
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And now in 2026, we've taken this huge step forward.
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in establishing our own medical programs as part of the CMS ACCESS model.
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And what's really interesting, Eddie, right, is as far as I know, this is really the
first time that we have this fully vertically integrated technology stack delivering
care.
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Everything from how the hardware is developed to how the data is analyzed and made
intelligent to how those clinical protocols are delivered to the patient.
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And that's really exciting to me.
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And the big reason why I joined Withings last year was to make that reality.
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And yourself, Eddie, tell me about your story, about how you started Rainfall and
what got you into the value-based care space.
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Yeah, sure thing.
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I feel like it's not dissimilar from your own journey, which is around seeing so
much so many gaps in care.
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considering where we are.
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my mother's a practicing physician in a rural town still to this day in rural
Arkansas.
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And when neighbors, friends, community members have to drive three, four, five hours
to get
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access to their entire care continuum.
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it shows you that again, technology has to be the answer to help scale it.
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that's why I founded Rainfall Health and that's why we're here talking to you and
other amazing folks that we end up having on the program to discuss how those
challenges that
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remain still you know rampant in healthcare and sometimes how do we make it just a
little bit better?
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How do we make lives just a little bit better?
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And I you brought up the CMS
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ACCESS model, CMS has been doing a lot of innovation.
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I feel like not everybody realizes that a lot of innovation actually in healthcare
and in other industries as well comes from government and government policy.
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I'd love to hear how do you all view
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the the model changes and the innovation coming out of CMS and also help us define
the CMS ACCESS program through your lens and the Withings lens.
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Yep, absolutely.
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And I like the way you spoke about the continuity because one of the core principles
that I've always had and Withings has always had and how CMS ACCESS is focused on is
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Delivering care in the home environment seems so common sense, but very difficult to
execute on before the ACCESS model.
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So if you think about before the ACCESS model, integrating technology into
healthcare was a difficult endeavor because of the way payments were structured, but
also how
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distribution occurs in healthcare.
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Everything is being done through the patient-physician relationship.
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And payment has been done in the fee-for-service activity basis.
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Technology is not an activity based sector.
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It's really about outcomes and impact.
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So the ACCESS model, when it was first launched by CMMI, we were so excited and we
remained very excited with our first cohort of patients coming in, is around this
real
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idea that we can move away from activity based.
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reimbursement mechanisms towards an outcomes-based reimbursement mechanism.
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What's different here as well is unlike total cost of care or utilization-based
contracts, this is focused on clinical outcomes.
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So improvement of blood pressure, getting weight loss metrics, improvement of
cholesterol in a patient population.
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It's really exciting because it allows us to really focus on what matters most,
which is those clinical outcomes and not necessarily, focus on the cost of care of
that patient.
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We partner with organizations who focus on cost of care.
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The second piece is the distribution, and it's often overlooked, but one of the core
pillars of ACCESS is making so that beneficiaries can get access to the technology
and the
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care that they want.
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And that patient choice is a core pillar of everything here.
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So the ability for Withings to be able to reach out to beneficiaries directly and
say, would you like to join this program?
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Because now Withings is a Part B medical group supplier.
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much like a cardiologist or a primary care physician billing Medicare, Withings is
now billing Medicare in this outcomes-based payment model.
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ability to get paid on outcomes, the ability to engage and reach out and distribute
our programs directly to beneficiaries are both, I think, transformational.
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And they both enabled us to integrate AI and technology much more efficiently
because of that.
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So it's been really a refreshing new twist to how we deliver value-based care.
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And in my perspective, the biggest bet on value-based care since the creation of
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of MSSP 10 plus years ago.
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So we're incredibly excited about it.
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I I you know, before we even started recording, we had this conversation around
there's very few people who find CMS models as exciting as I do.
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So I'm I'm glad that you know, we stay on the same wavelength about the excitement
of what this means and not just for us, our team, our companies, but actually most
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importantly for the patients and the U.S. healthcare system.
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One of the things that you mentioned that I think is so exciting is the other
entities that you work alongside.
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other care providers to actually deliver those outcomes that we all care about.
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So tell us a little bit about how who those are and how you all fit together.
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And what's been on my mind, especially in
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the last couple of weeks, is there's this great article that was written by a
clinician that mentioned the, you know, had a provocative headline that said, the
healthcare
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system is now broken.
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It's doing exactly what it's intended to do, which is
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separate pieces delivering their own care in their own silos.
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It's never designed
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as a system.
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And I think that's what these models are allowing us to do.
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So shed some light on how you all work with other care providers, other care
delivery and technology companies to make that impact.
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Yeah, I like the way you framed that.
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The system is designed to be somewhat fragmented, especially with the fee for
service system.
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So we approach this, we have a history of working with health systems, ACOs,
initially around remote monitoring.
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So we have dozens of health systems are working with us today with our technology.
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Now in the ACCESS model, which is Withings delivering care for hypertension,
prediabetes, high cholesterol, obesity, ASCVD, the CKM spectrum.
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The way we're approaching this is integration back to the traditional healthcare
system is not a nice to have, it's a must have.
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Now we're leveraging those EHR integrations that we have with health systems on
remote monitoring, but we're doing it now for care coordination.
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And how do we define in scope of what Withings is delivering care on?
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So, you know, those are things like getting labs and managing medications, all with
the purpose of
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let's have this patient be on guideline-directed care.
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There's nothing new under the sun here when it comes to managing the spectrum of
conditions.
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What is new is how technology can enable it to touch more patients and how clinical
variability when it comes to getting patients on guideline-directed care can be more
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seamless.
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So we're integrating back with PCPs, we're, as CMS would call it, co-managing
patients, and it's been a really interesting new layer of care.
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because we were going through credentialing for another payer and it was, are you
primary care, specialty care, urgent care?
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We're like, we're none of the above.
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We're something new.
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We're a technology-based care provider that is there to integrate back to the health
system, integrate back with the PCP.
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It's a different layer of care.
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I'm curious, Eddie, because you see so much on the other side, right, on the health
system side.
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You know, when you think about these expansive
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CMMI models like ACCESS, which are different than the more condition specific ones,
how do you kind of think about that from your lens?
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Yeah.
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I think for for us we're kind of building the ship as we sail it with these models.
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And I think that's the most important thing to understand is we actually get to
architect a way to work together and set up these systems from the ground up.
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I think one of the hardest things in healthcare is ripping out existing
infrastructure to input new ones.
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I think this is the chance and I think that's what
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CMS and CMMI have been doing that's so brilliant is starting afresh.
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So we can actually
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architect the system of our dreams as if you will, you know, as we move forward.
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And that means that we get to define these relationships from the ground up.
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where do we find that we want data to flow?
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Where do we find we want actual care delivery and services to go?
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And how do we get closer and closer?
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Where the patient already is.
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So from our lens, we think
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it's mostly about how can you create a unique experience for every patient.
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And it's almost less about everyone else.
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we spend a lot of time with health systems, and I think that you know the best thing
to deliver patient satisfaction, quality of outcomes, and cost management is
actually to
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interact with the patient.
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only as much as you need to.
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That's so interesting, right?
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you'd
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think that if you wanted to be really responsive, you spend much more time with the
patient.
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Actually, patients want you to only be there for as much as they need you.
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if they're doing fine and they can manage it with, some of the devices and stuff,
for example, you all provide, I actually think that's the win is you can actually
manage the
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outcomes that the patient cares about, the clinicians care about.
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and what Medicare as the payer cares about by actually engaging a little bit less,
but at the right moments, at the right time with the right data, so that you're not
recreating
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and you're only engaging at the points that create that value.
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So it really is about with the evolution of AI and where it is today, I think we can
actually manage this sort of
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as you alluded to a long-promised dream of value-based care, that we can actually
personalize it.
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And that leads me to my next question for you, which is how are you all leveraging
AI?
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and how do you think it drives the patient outcomes and experience that are so core
to clearly what you all provide?
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Yeah,
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and it segues, it's a good segue from what you mentioned earlier about the
experience and engaging the patient at the right time.
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In my past, one of the things I've both loved about value-based care, but
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have seen friction is the clinical care models that are developed by organizations,
whether in health systems or technology-based organizations, are in a vacuum very
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effective.
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they have, there's no mission without margin.
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In a vacuum, they work.
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What doesn't always work is does a patient want to be a part of this?
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And
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How do you handle these multiple taping of pieces together, especially hardware
pieces that are required for CKM conditions?
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What's happening here is the patient is always a consumer, and there's this huge
interest going on in healthcare around the use of wearables, the use of at-home
devices for...
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self-management, understanding oneself better, and that's where we're meeting the
patient where they are.
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So, Withings has this long consumer history.
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We have over 15 million users around the world, 5 million users in the US, almost a
million are 65 plus, and we're starting the relationship with the patient with,
want, the
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patient wants, the consumer wants to know more about themselves.
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Let's start with that entry point.
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Here is a...
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a scale that can measure your body composition that can do a lot more.
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Here's a blood pressure monitor that can do a lot more.
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And we start with that relationship and we can deliver medical care on top of that.
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Where we're integrating AI is how do we automate all the administrative tasks, and
I'm sure you're well familiar with all this, that increase the cost without
improving the
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outcomes.
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you know, getting a patient onboarded,
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is a set of administrative tasks that don't improve the outcomes, but are
requirements for us to just deliver care.
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So we've applied a lot of AI there.
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And now what we're looking at is how do we start applying AI so that that promise we
make to that patient, right, of you're going to understand more about yourself with
these
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devices and all of our markers are FDA cleared.
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We're applying AI to help surface information, help drive insight.
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to the patient.
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We're developing AI right now, and it's been very exciting.
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How do we help our clinicians and our clinical team, our nurse practitioners,
clinical pharmacists, also supervised by medical directors, how do we help our
clinicians be able to
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digest and make sense of all this data that's coming in?
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So patients have two, three devices.
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And know when is the right time?
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When is the opportune time?
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to make a medical decision.
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So we're very big right now on AI as enabling better decisions.
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We're big believers in how this technology is going to grow and be more powerful.
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But every decision at the end of the day is going to be made by a clinician.
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Every decision is going to be made by a patient.
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We're just using AI to make that process more seamless and also surface the right
information at the right time.
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And that's been so effective already.
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We had testimonial from one patient who was at the
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ACCESS launch event, who defined it as, this is a new way of, this is a new
healthcare system that is more proactive and responsive to my needs.
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And that really stuck with me, because if we can do this in the home environment,
and we integrate it back into the broader healthcare setting, which we're doing,
that means the
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whole healthcare system becomes more proactive and responsive to the needs.
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So we're taking this step by step,
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But I'm curious because you are dealing with AI all the time as well.
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I'm curious about how you're thinking about this technology and its applicability in
value-based care.
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well, thanks for inviting me into the AI discussion.
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for us,
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it's, we have a privilege of working alongside brilliant folks like yourself who are
on the front lines in the same way, right?
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Like collecting the data and being there with the patient.
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And we get to see it across different specialized verticals, across several service
lines.
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And we also then get to see that information and how it needs to get used within for
Rainfall Health.
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We do it as episode care management.
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So that means it's always time bound in areas and windows that are most impactful to
the patient journey, right?
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30 days post surgery,
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90 days post-surgery.
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There's a lot of data that shows that if we can manage patients in that time period.
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We actually really improve their long-term viability and long-term care and
outcomes.
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And so for us, it's all about taking data that's coming from all these different
sources and actually giving it a standard.
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And and by that, it's not dissimilar from your approach of taking data streams, but
the way we define standards is what it means in terms of quality.
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for the clinicians across different geographies, across different timelines, across
different episodes.
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And the AI piece for us is trying to both translate some of that stuff to the
clinician so that they know the action
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steps that are needed.
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And again, we're big proponents of always keeping the patient and the clinician at
the center of everything that's happening.
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And from the patient perspective, being able to meet them in terms of where they
already are and translating what's happening to them.
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And by that I mean we have our AI voice caller that speaks 76 different languages
that can help the
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patient just navigate what's happening to them.
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So that so they know all the possibilities of what to do.
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And that usually means that.
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Any patient might see as many as a dozen different care providers in that 30 day
episode.
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But from the patient perspective, there's sort of like one advocate, one touch point
for them that can help navigate through that entire piece.
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And for Rainfall, it's really about enabling other folks to shine, right?
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Whether it's hardware.
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combined with software like Withings or it's, you know, somebody just on a pure
services side or even brick and mortar like skilled nursing
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facilities.
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It's really about the patient flowing through the system and making sure that they
are in a great place overall and tracking it in terms of those components that I
mentioned,
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which is patient satisfaction, which is just as important as quality of care.
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which is just as important as outcomes and cost management, because you can't really
have all three working, you have to have all three working in unison.
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You can't really be taking one or the other out of the equation.
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so that's at least how we tend to view it.
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That's really, that's great.
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You one of the use cases I'm very obsessed with right now that
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And again, we have the benefit of having millions of consumers working with us and
tremendous amount of data is we've been able to develop and we had a publication in
the
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Mayo Clinic recently about predicting GLP-1 outcomes based on early, early data
points that we collect with our body composition scale.
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And that's been something that we've shown to our clinicians, like, is this
something of clinical value?
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And it's been incredibly instructive, not just for clinicians to be able to assess
titration schedules, but also the patient feels way more at the center of what
they're
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doing, which is kind of just on what Rainfall, right?
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The patient is a consumer and we've, historically, we haven't done a great job of
bringing that standard experience that a consumer would expect to healthcare.
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So what we're seeing here is that now the patients are able to see, how is my weight
loss going to project?
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And they're making better decisions.
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They feel more informed about their own health.
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And it's been helping us achieve better outcomes.
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So there's so much that can be done.
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And it really starts with, is this going to be part of a patient-centered goal?
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We have clinical outcomes targets.
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We have patient-centered goal targets.
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Is this part of a patient-centered goal target?
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is something that we can safely use, which is another big part you spoke on, too you
know, the, you're, dealing with, and in Rainfall, you're working with well-approved,
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well-respected medical providers and devices.
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Withings, we take a similar approach here, but on the device side, we're big on FDA
clearance.
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So any data that is coming back to our clinicians, they can safely act on it.
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And I think that's another piece that we're looking at a lot right now, which is
consumers are very interested in what's going on devices.
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Most of them are not FDA cleared devices.
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They're wellness devices.
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And that's a huge difference because a wellness device means, hey, and consumer or
patient, this is a wellness device.
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You can do with this what you wish, but there are risk associated and this is not.
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reviewed or approved by the FDA.
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And the patient has a very limited toolbox of what they can do.
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They can sleep better.
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They can maybe change their activity.
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When an FDA clearance comes in, now the toolbox expands.
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And it's no longer, hey, patient, here's what you can do.
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Now it's, hey, patient, here's what we can do together.
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We can put you on a second line therapy for your hypertension.
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We can titrate that medication based on this data point.
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So we're thinking a lot about this too.
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which is the AI is fantastic, what data is going into the AI so that when the
actions are occurring, we have the biggest toolbox possible in terms of actions
taken.
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Wow, that's such a differentiated approach in many ways where it you know, from
where we are standing and we spend a lot of time on these standards and you know,
folks that want
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to raise their hand and say, We're gonna go above and beyond the minimum
requirements.
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And that's what
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I'm hearing that Withings is trying to do and is doing successfully, which is going
to FDA when you don't necessarily need to, right?
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You'll still have the consumers, you'll still be able to get them
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even if it's a limited set of services, but you're going to FDA.
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You're raising your hand and saying, please judge us as a third party, do that
audit, because we feel so comfortable that we're willing to put our devices and our
technology
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for scrutiny.
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And that's such an amazing way to gain trust and also showcase why
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there's a differentiated space that you all can play in.
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And then that is
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truly what leads to being able to provide that better experience.
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Is that kind of how you all tend to also look at the strategy, which is like, hey,
look, we think we
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are delivering a better product and we wanna be able to showcase it.
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Absolutely.
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We've been, there's been this gray line, right, between the consumer and the patient
that's been, you know, as we've all been playing and understanding how do we make
this a
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strong
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integration between the consumer and the patient.
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And our belief is one of the big things is the data that is used by a consumer needs
to also be able to be used by a clinician.
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And the way to do that is through FDA approval, FDA review.
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That's a huge piece of what we think about.
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It also we have the benefit of thinking long term.
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So Withings is a large, but we're still founder-owned.
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company, we're a profitable company, we have a long term vision that we're trying to
execute on and we don't get distracted by the short term possible wins.
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We're thinking long term about how does an individual be able to prevent and manage
chronic conditions at home and our belief at the end of the day is enabling that
data
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point to be used by the person at home and by their clinician with the biggest set
of toolbox possible so they can
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manage their needs.
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we're always going to go above and beyond.
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We're going above and beyond by setting up our own medical group.
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We're going above and beyond because we think it's common sense that there should be
a continuity of care that goes from the in-person to the virtual into your home,
even into
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your bathroom scale that you stand on every morning.
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That's our core belief, and we're going to be focusing on that.
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That's so amazing.
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And, again, a differentiator approach, which does again come back to the core
foundings and how you all are set up.
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Now I'm going to switch gears just a little bit away from the patient because even
though that's such an important tenet of all care that we provide, to the clinician,
who's
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another,
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huge component of this.
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You mentioned you're working with multiple health systems, including MedStar.
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Who do you engage with at the system level?
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how because again, a lot of our audience are health system executives, and who are
the right folks that you would engage with that you get to showcase both the power
of what
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you're building and providing to the patient and also how you can probably make
their lives easier and deliver better care, right?
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Like that's always how we have these amazing executives who all care and want the
same goal, but sometimes
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You know, it's just so complex.
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So how do you how would you break it down on how you approach these different
systems and what does the value provide and to which leaders?
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we have fantastic relationships with our health system organizations working at
really two levels, the population health level as well as the virtual care and
digital health level.
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And we work with our partners in two ways.
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One way is, and like you mentioned, the 90 day episodes and the readmission windows,
we work with our partners a lot on heart failure, readmissions work.
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So, and one of the key reasons why we have a number of heart failure readmission
programs where we provide technology to our health system partners to be able to
have reductions
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of readmission rates is we do a couple things really well.
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One is we integrate data back very cleanly.
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Two is we've innovated device hardware and firmware.
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So we identified pain points.
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For example, in heart failure management, it's part of evidence-based guidelines to
collect not just weight, but also, and blood pressure, but also symptom surveys.
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And what we saw in the market with our partners was through their existing portals,
they would get 30, 35% adherence from their patients to these symptom surveys.
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And that lack of adherence means there's less visibility into the patient health,
which means
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higher readmission rates.
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What we've done, for example, is that we've designed our blood pressure monitor to
be able to, on the blood pressure monitor, believe it not, collect symptom surveys.
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The result of that is that we have an 89% adherence to symptom surveys.
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So we've been able to design hardware and firmware to meet the needs of specific use
cases.
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Heart failure is one of them, which is really big with population and virtual care
teams.
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The other one is hypertension management.
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For patients who are higher acuity hypertensive and polychronic and would benefit
from more integration with the healthcare system, we have on that blood pressure
monitor
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the ability to better educate on how to take a blood pressure reading.
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Also on the blood pressure monitor, we have the opportunity for patients to be able
to do automated retake.
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And these features are really interesting, Eddie, right?
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When we have our fee for service organizations who speak to us, they say, wow, this
is so efficient.
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That's horrible, because it's going to reduce our activity billing because we're
making fewer phone calls.
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When we have value based organizations who look at this feature, they say, this is
amazing because I'm going to save my clinicians time calling for retake.
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So we're thinking about these small pain points to make.
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virtual management more efficient and effective and that's been widely popular with
our health system partners.
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Now that we are doing lower acuity care ourselves, now we're working a lot more with
population health and virtual care, but through the way of how do we identify who's
eligible and
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who's really going to benefit from this type of program.
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But also for patients that we enroll that may not have known the system before,
right?
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Because we have 5 million users around the country.
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How do we get them back into the health system?
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If they need an echo, can we do a direct referral back?
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If they need a cardiology visit, can we do a direct referral back?
354
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So it's been a very exciting scope of partnerships and how we work with population
health and virtual care leaders.
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That's amazing.
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And, you know, again, really speaks to when you can align incentives from this sort
of policy lens, it really does drive the right outcomes
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and the right alignment across the entire network from patients all the way to the
payers, providers, clinicians, and everybody along the way to help make that happen.
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now, you know, as we start to think about all the data.
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that's being created and what are the insights that you're most excited about?
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What's, you know, that they'll help unlock now that we are able to start you know,
getting closer and closer the patient in the moment that we we have some sort of
insight
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to actually the care delivery, which some it sounds like some sometimes Withings can
provide.
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And then also going all the way to, you know, a specialized higher acuity care need
as well.
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What do you think it's going to unlock?
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It's a fantastic question.
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know, from at the end of the day, time to control for most of this population is,
think, all of our guiding principle.
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Now, readmissions are a very important metric, but it's a downstream effect of
getting a heart failure patient under control and stabilized.
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So we're always thinking about that component to it.
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What we see
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is when the patient is engaged in their own care, and our belief at Withings is that
the device is a core piece of that care that they get, and that data is helping
inform
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clinician decisions, we can accelerate time to control tremendously.
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The other piece of this, is as patients become more consumers and are thinking about
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What experience of care do they want?
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We're thinking a lot as well about patient satisfaction as being one of the core
pillars.
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Not just getting patients under control, but were they happy with the experience?
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Is that an experience that they are choosing with their feet, right?
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And to join.
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We waive co-pays and our partners often waive co-pays on things like this as well.
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But NPS is becoming more more important.
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One thing is our approach to that is we design a premium experience with our
devices.
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I don't know, Eddie, if you have, but it's a premium experience that we make
available to all income brackets, all lines of business.
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00:36:53,969 --> 00:37:07,922
So much like we have our MedStar partnership in concierge medicine where patients in
those programs have resources to engage in higher touch care at MedStar.
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We also have FQHCs using the same technology for the same use cases, right, in the
Medicaid population.
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And that's been our guiding principle, right?
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So great data, FDA-cleared data to the patient, to the clinician, and an experience
that the patient is going to want to engage in, regardless of means to pay, is what
we are
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always thinking about here.
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And we've seen that with high activation rates.
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So...
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When a patient signs up, historically in my life, I've seen a number of programs
where even when they want to sign up, they don't start the program because once they
sign up,
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they're kind of like, what am I getting myself into?
390
00:37:47,084 --> 00:37:55,869
At Withings, 94% of those who enroll in our partners programs, hypertension and
heart failure, start the program.
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They are collecting data.
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92% engage month over month in a clinically meaningful way.
393
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and over 90% still use their device at the end of 12 months, that enables a much
more effective care model that the patient is gonna come back to the system and is
gonna come
394
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back and feel like they're being heard and that they're gonna want more support,
more services from that system.
395
00:38:23,228 --> 00:38:32,988
So that's how we think about it a lot, Eddie, is get the outcomes but do it in a way
that the patient experience is also top of mind.
396
00:38:33,990 --> 00:38:34,940
No, that's amazing.
397
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And such an again, an amazing way to look at the entire experience.
398
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It's if you listen to any of the other episodes of our podcast, I really talk a lot
about my personal mission around access to care.
399
00:38:47,754 --> 00:38:59,567
And I think that's fundamentally what you all are driving towards with experience
also still front of mind, but access so that we can make it more available to the
people who
400
00:38:59,567 --> 00:39:00,938
need it the most as well.
401
00:39:00,938 --> 00:39:02,650
that's
402
00:39:02,650 --> 00:39:03,401
so powerful.
403
00:39:03,401 --> 00:39:06,255
I it's it making me feel like I'm missing out on something.
404
00:39:06,255 --> 00:39:12,642
I'm gonna I'm gonna have to go to Withings and try to see what what I can get for
myself and find out more about my own data.
405
00:39:12,703 --> 00:39:14,216
maybe we'll
406
00:39:14,216 --> 00:39:14,958
going to be possible.
407
00:39:14,958 --> 00:39:24,515
The more and more payers are going to start covering for these types of ACCESS
services, we'll all be eligible for these, not just original Medicare.
408
00:39:24,515 --> 00:39:31,798
And I think the difference between remote monitoring with health systems and this
ACCESS model is worth speaking about too.
409
00:39:31,798 --> 00:39:36,180
So I think it touches on what is
410
00:39:36,819 --> 00:39:42,963
how integrated or sorry, how tied to the hospital should this patient be?
411
00:39:43,424 --> 00:39:51,148
For a patient that's coming out, they have multiple hospitalizations, multiple ED
visits, remote monitoring is gonna be the best way to do this.
412
00:39:51,148 --> 00:39:57,832
We want really small patient panels, very closely tied to that discharging hospital.
413
00:39:58,093 --> 00:40:05,957
And for patients who may not have an ED visit or an acute event, but like many of
us,
414
00:40:06,504 --> 00:40:21,317
going down the risk spectrum from obesity into hypertension to diabetes, ACCESS
becomes a fantastic service to have more preventive healthcare at a very low cost
structure that is
415
00:40:21,317 --> 00:40:22,658
no copay to patients.
416
00:40:22,658 --> 00:40:34,638
So I think also the type of access to care is being kind more formalized, which has
been very, very clarifying on the Withings side.
417
00:40:35,637 --> 00:40:36,958
No, that's so exciting.
418
00:40:36,958 --> 00:40:40,030
And I I'm excited to see where it keeps going.
419
00:40:40,030 --> 00:40:50,096
And it's it's great to see these enablement models instead of, you know, the
responses that have come out in the past, which is not yet another model.
420
00:40:50,257 --> 00:40:50,947
so it's great
421
00:40:50,947 --> 00:40:56,519
the ones that actually get to the heart of what we're trying to achieve have from
that like larger vision.
422
00:40:56,519 --> 00:41:04,764
as we start to think about, you know, wrapping up this incredibly exciting podcast,
and I could keep talking about this for hours.
423
00:41:04,796 --> 00:41:10,384
what are you most optimistic about in the next three to five years?
424
00:41:12,708 --> 00:41:13,828
I
425
00:41:14,969 --> 00:41:28,737
think we're on a path right now where technology-based companies like Withings, who
are both entering healthcare or enabling, and Withings we do both,
426
00:41:28,737 --> 00:41:39,630
We enable through remote monitoring, we go directly to patients for lower acuity,
are now having a more meaningful seat at the table of value-based care.
427
00:41:39,630 --> 00:41:52,614
whereas I felt a stagnation in this transformation that we've been part of since the
mid 2010s, now I see this reinvigoration of the value-based care movement
428
00:41:52,614 --> 00:41:56,805
because technology companies are having a seat at the table.
429
00:41:58,139 --> 00:41:59,690
not overlapping.
430
00:41:59,690 --> 00:42:09,137
So we are not, we are focused on the outcomes and we partner with our organizations
who are focused on the cost of care, quality measures, utilization based.
431
00:42:09,137 --> 00:42:13,359
But because we have our own seat at the table now, so much more can be done.
432
00:42:13,359 --> 00:42:25,197
And what that so much more can be done, I think of things like, you know, our
ability to predict GLP-1 outcomes, our ability to predict heart failure congestion,
it allows us to
433
00:42:25,197 --> 00:42:27,829
really invest a lot more into
434
00:42:27,837 --> 00:42:38,485
not just the individual biomarkers, but that overall AI sensing layer about what do
these FDA approved markers mean, so we can be more proactive in care.
435
00:42:38,485 --> 00:42:45,740
And that's really enabled because we have a seat at the table now, because now we
can safely invest into these technologies.
436
00:42:45,740 --> 00:42:54,316
And we've seen it already in the past nine months to a year, what we can build once
there's clarity about our role in the value-based care movement.
437
00:42:54,316 --> 00:42:56,817
So that's been very exciting.
438
00:42:57,116 --> 00:43:08,681
I don't want to say what's going to happen in three to five years, but I think there
are ways for us to be able to really bend the cost curve on chronic conditions.
439
00:43:08,681 --> 00:43:17,395
And I think there are ways that we can get everyone engaged in some preventive
healthcare, most notably hypertension.
440
00:43:17,395 --> 00:43:22,003
I think in three to five years, the idea of having, you
441
00:43:22,003 --> 00:43:33,183
Over 40, 50% of hypertensive uncontrolled, I think it's gonna look a little bit
crazy in three to five years once people all have the technology to monitor and the
access to care
442
00:43:33,183 --> 00:43:36,263
to properly treat a condition like hypertension.
443
00:43:37,648 --> 00:43:39,772
I feel like that's the future I can get behind.
444
00:43:40,837 --> 00:43:46,882
Patrick, what have we not talked about that you won't that we want to cover before
we wrap up today?
445
00:43:48,338 --> 00:43:50,979
I think this was an amazing conversation, Eddie.
446
00:43:50,979 --> 00:43:53,119
It's refreshing to speak with you.
447
00:43:53,119 --> 00:43:54,859
It's great to see you again.
448
00:43:55,399 --> 00:43:59,459
I would love to hear from your perspective, right?
449
00:43:59,459 --> 00:44:02,939
Because you deal in lot of episode-based models.
450
00:44:02,939 --> 00:44:06,819
One of the things about ACCESS is it's a longitudinal-based model.
451
00:44:07,279 --> 00:44:16,891
Maybe we can talk about this over coffee another time, but the way the overlap of
episode-based models and longitudinal models and...
452
00:44:16,891 --> 00:44:23,609
I'd love to hear more from you about what you think about that, but that could be a
separate conversation altogether.
453
00:44:24,176 --> 00:44:26,156
Well, it's good for us to tease it here.
454
00:44:26,156 --> 00:44:38,924
I think just on a high level, I just wanna leave that's a good place to leave
everybody, which is I think there is so much space and so much white space actually
for us to build
455
00:44:38,924 --> 00:44:45,067
on in both areas and drive better value, both in the short term where we see
456
00:44:45,196 --> 00:44:54,160
an acute event that's taking place and how to manage that versus really how do you
manage a better life.
457
00:44:54,160 --> 00:44:55,121
as a whole.
458
00:44:55,121 --> 00:45:01,708
And I think both of those have the same goal, but they're just driving at different
459
00:45:01,708 --> 00:45:02,267
stages.
460
00:45:02,267 --> 00:45:06,150
And I think the value is spread out over time.
461
00:45:06,150 --> 00:45:20,002
It's it reminds me of when there was a big literature finding back again in the
early 2010s that said only about 30% of your care and your outcomes are dependent
462
00:45:20,002 --> 00:45:22,424
on clinical information.
463
00:45:22,446 --> 00:45:23,877
The rest of it happens at the home.
464
00:45:23,877 --> 00:45:25,288
It happens in social settings.
465
00:45:25,288 --> 00:45:27,180
It happens in everything else.
466
00:45:27,360 --> 00:45:33,866
And what was always amazing to me about that is we only capture that 30% on the
clinical side.
467
00:45:33,866 --> 00:45:45,386
And now with technologies that are coming out, I think we have that ability to
stretch that into that remaining 70% and strive for that overarching goal that we
may never get to
468
00:45:45,386 --> 00:45:46,307
of a hundred percent.
469
00:45:46,307 --> 00:45:47,678
But hey, that's that's
470
00:45:47,678 --> 00:45:50,350
the frontier that we keep striving towards.
471
00:45:51,458 --> 00:45:52,058
I love it.
472
00:45:52,058 --> 00:46:00,041
Yeah, I think the if I think about ACCESS V2 right in 2027, 2028, I think this
473
00:46:00,047 --> 00:46:06,927
know, this integration between episode-based models and this longitudinal model is
going to be really exciting.
474
00:46:07,087 --> 00:46:11,807
And what does it mean for a transition of care back into the home environment?
475
00:46:12,247 --> 00:46:20,227
I think it's a point that we're going to be thinking about, and it's going to be a
really exciting time on this.
476
00:46:20,227 --> 00:46:23,307
So thank you very much, Eddie, for having me on here.
477
00:46:23,307 --> 00:46:28,927
And I look forward to diving deeper with you over coffee another time as well.
478
00:46:29,530 --> 00:46:31,659
Patrick, thanks so much for coming on.
00:00:05,266 --> 00:00:10,888
This is Eddie Qureshi, founder and CEO at Rainfall Health, and the host of this
podcast.
2
00:00:10,888 --> 00:00:13,349
Today on the podcast, we have Patrick Sheehan.
3
00:00:13,349 --> 00:00:21,353
He's a healthcare leader at the intersection of technology and care delivery focused
on virtual and at-home services for people with chronic conditions.
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00:00:21,373 --> 00:00:31,897
As VP of value-based care at Withings Health Solutions, he partners with
risk-bearing organizations to design and scale programs that improve affordability,
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00:00:31,897 --> 00:00:34,066
outcomes, and the care experience.
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00:00:34,066 --> 00:00:45,192
His recent work with Withings includes MedStar Health to bring connected devices
into the concierge primary care and Withings' acceptance into the CMS ACCESS model
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00:00:45,192 --> 00:00:49,235
for technology-enabled chronic care for Medicare beneficiaries.
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00:00:49,235 --> 00:00:59,581
Right now, we're gonna dive into everything CMS, everything Withings, but let's just
start off with you, Patrick, which is what got you interested
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00:00:59,581 --> 00:01:01,958
in value-based care and
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00:01:01,958 --> 00:01:04,605
risk bearing organizations of all things.
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00:01:05,274 --> 00:01:11,526
Yeah, and first off, thank you, Eddie and the team for having myself join this
podcast.
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00:01:11,526 --> 00:01:14,577
I am a huge fan of what you're doing at Rainfall as well.
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The community in the value-based care is, I think, of greatest joys of playing in
the value-based care arena is the community of all of us trying to make life better
for
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patients.
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I got into this space
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00:01:29,180 --> 00:01:43,169
Early on, when we look at the Affordable Care Act in the early 2010s, I had the
privileged opportunity to be at Dartmouth during that period, and Dartmouth was one
of
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the policy hubs for this accountable care organization.
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00:01:47,272 --> 00:01:58,399
And it really inspired me about what could be in healthcare by better aligning
incentives and spurring innovation towards a better healthcare system for all.
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00:01:58,415 --> 00:02:13,019
And that's led me down a very exciting path, initially at a Medicaid ACO, but then
around the turn of early 2010s, late 2010s, early 2020s, late 2010s, I started
working with
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00:02:13,019 --> 00:02:14,559
virtual care companies.
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00:02:14,559 --> 00:02:20,960
And the idea of delivering care virtually was not only feasible, but seemed also
impactful.
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00:02:20,960 --> 00:02:27,387
And that's now led me to Withings in the work that we're doing here.
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00:02:27,387 --> 00:02:29,407
You know, Withings has a long history.
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00:02:29,407 --> 00:02:40,367
I'm sure we'll get into it, Eddie, but I believe that technology is the greatest
enabler of value-based care, and I'm most excited today about what AI can do to, you
know,
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00:02:40,367 --> 00:02:45,187
accelerate what is now more of a stagnant value-based care movement overall.
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00:02:46,142 --> 00:02:53,250
I couldn't agree with you more about value based care and as a entire market sector
and the people who help prop it up
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00:02:53,250 --> 00:02:55,202
and technology which helps us scale it.
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00:02:55,202 --> 00:02:57,154
I couldn't agree more, Patrick.
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00:02:57,235 --> 00:03:03,792
But for people who are a little bit less familiar with Withings, tell us what do you
all do and how do you do it?
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00:03:03,792 --> 00:03:04,652
Yeah, absolutely.
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So, Withings is a very interesting history that starts with the idea in 2008, 2009,
the idea of stepping on a device at home and that device's recordings, the
biomarkers, coming
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back in a digital format on a smartphone.
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And that basic, simple idea was the first time that happened.
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And that set off a long course of innovation.
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where we've layered in other value propositions over the last 16, 17 years.
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00:03:33,630 --> 00:03:42,892
So what started off as a device ecosystem, and today we do weight scales, blood
pressure monitor, urine analysis, a number of devices.
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00:03:42,892 --> 00:03:45,933
Now we are also providing data intelligence.
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00:03:45,933 --> 00:03:54,795
So whether we're doing remote monitoring with health system partners, or we're
providing more insight to our consumers.
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00:03:54,915 --> 00:03:59,036
And now in 2026, we've taken this huge step forward.
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in establishing our own medical programs as part of the CMS ACCESS model.
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00:04:04,247 --> 00:04:16,054
And what's really interesting, Eddie, right, is as far as I know, this is really the
first time that we have this fully vertically integrated technology stack delivering
care.
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Everything from how the hardware is developed to how the data is analyzed and made
intelligent to how those clinical protocols are delivered to the patient.
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And that's really exciting to me.
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00:04:29,532 --> 00:04:34,290
And the big reason why I joined Withings last year was to make that reality.
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00:04:34,290 --> 00:04:42,663
And yourself, Eddie, tell me about your story, about how you started Rainfall and
what got you into the value-based care space.
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00:04:42,799 --> 00:04:43,789
Yeah, sure thing.
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00:04:43,789 --> 00:04:52,312
I feel like it's not dissimilar from your own journey, which is around seeing so
much so many gaps in care.
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considering where we are.
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00:04:54,359 --> 00:05:00,884
my mother's a practicing physician in a rural town still to this day in rural
Arkansas.
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00:05:01,045 --> 00:05:06,506
And when neighbors, friends, community members have to drive three, four, five hours
to get
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access to their entire care continuum.
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it shows you that again, technology has to be the answer to help scale it.
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00:05:14,218 --> 00:05:25,364
that's why I founded Rainfall Health and that's why we're here talking to you and
other amazing folks that we end up having on the program to discuss how those
challenges that
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remain still you know rampant in healthcare and sometimes how do we make it just a
little bit better?
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How do we make lives just a little bit better?
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And I you brought up the CMS
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ACCESS model, CMS has been doing a lot of innovation.
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I feel like not everybody realizes that a lot of innovation actually in healthcare
and in other industries as well comes from government and government policy.
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I'd love to hear how do you all view
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00:05:56,316 --> 00:06:08,963
the the model changes and the innovation coming out of CMS and also help us define
the CMS ACCESS program through your lens and the Withings lens.
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Yep, absolutely.
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And I like the way you spoke about the continuity because one of the core principles
that I've always had and Withings has always had and how CMS ACCESS is focused on is
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Delivering care in the home environment seems so common sense, but very difficult to
execute on before the ACCESS model.
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So if you think about before the ACCESS model, integrating technology into
healthcare was a difficult endeavor because of the way payments were structured, but
also how
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distribution occurs in healthcare.
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00:06:43,701 --> 00:06:48,323
Everything is being done through the patient-physician relationship.
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And payment has been done in the fee-for-service activity basis.
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Technology is not an activity based sector.
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It's really about outcomes and impact.
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00:07:01,594 --> 00:07:11,282
So the ACCESS model, when it was first launched by CMMI, we were so excited and we
remained very excited with our first cohort of patients coming in, is around this
real
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idea that we can move away from activity based.
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reimbursement mechanisms towards an outcomes-based reimbursement mechanism.
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What's different here as well is unlike total cost of care or utilization-based
contracts, this is focused on clinical outcomes.
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00:07:30,918 --> 00:07:40,596
So improvement of blood pressure, getting weight loss metrics, improvement of
cholesterol in a patient population.
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00:07:40,596 --> 00:07:52,039
It's really exciting because it allows us to really focus on what matters most,
which is those clinical outcomes and not necessarily, focus on the cost of care of
that patient.
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00:07:52,039 --> 00:07:55,550
We partner with organizations who focus on cost of care.
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00:07:55,690 --> 00:08:07,733
The second piece is the distribution, and it's often overlooked, but one of the core
pillars of ACCESS is making so that beneficiaries can get access to the technology
and the
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care that they want.
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And that patient choice is a core pillar of everything here.
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So the ability for Withings to be able to reach out to beneficiaries directly and
say, would you like to join this program?
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Because now Withings is a Part B medical group supplier.
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much like a cardiologist or a primary care physician billing Medicare, Withings is
now billing Medicare in this outcomes-based payment model.
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ability to get paid on outcomes, the ability to engage and reach out and distribute
our programs directly to beneficiaries are both, I think, transformational.
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00:08:48,469 --> 00:08:55,011
And they both enabled us to integrate AI and technology much more efficiently
because of that.
85
00:08:55,011 --> 00:09:02,054
So it's been really a refreshing new twist to how we deliver value-based care.
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00:09:02,054 --> 00:09:07,367
And in my perspective, the biggest bet on value-based care since the creation of
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00:09:07,367 --> 00:09:10,166
of MSSP 10 plus years ago.
88
00:09:10,166 --> 00:09:12,442
So we're incredibly excited about it.
89
00:09:13,843 --> 00:09:21,878
I I you know, before we even started recording, we had this conversation around
there's very few people who find CMS models as exciting as I do.
90
00:09:21,878 --> 00:09:32,486
So I'm I'm glad that you know, we stay on the same wavelength about the excitement
of what this means and not just for us, our team, our companies, but actually most
91
00:09:32,486 --> 00:09:36,628
importantly for the patients and the U.S. healthcare system.
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00:09:36,669 --> 00:09:42,635
One of the things that you mentioned that I think is so exciting is the other
entities that you work alongside.
93
00:09:42,635 --> 00:09:48,148
other care providers to actually deliver those outcomes that we all care about.
94
00:09:48,148 --> 00:09:53,401
So tell us a little bit about how who those are and how you all fit together.
95
00:09:53,401 --> 00:09:57,443
And what's been on my mind, especially in
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00:09:57,443 --> 00:10:07,608
the last couple of weeks, is there's this great article that was written by a
clinician that mentioned the, you know, had a provocative headline that said, the
healthcare
97
00:10:07,608 --> 00:10:09,145
system is now broken.
98
00:10:09,145 --> 00:10:12,651
It's doing exactly what it's intended to do, which is
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00:10:13,267 --> 00:10:18,010
separate pieces delivering their own care in their own silos.
100
00:10:18,010 --> 00:10:18,860
It's never designed
101
00:10:18,860 --> 00:10:19,881
as a system.
102
00:10:19,881 --> 00:10:22,623
And I think that's what these models are allowing us to do.
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00:10:22,623 --> 00:10:33,659
So shed some light on how you all work with other care providers, other care
delivery and technology companies to make that impact.
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00:10:35,051 --> 00:10:37,619
Yeah, I like the way you framed that.
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00:10:37,619 --> 00:10:44,402
The system is designed to be somewhat fragmented, especially with the fee for
service system.
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00:10:45,378 --> 00:10:53,063
So we approach this, we have a history of working with health systems, ACOs,
initially around remote monitoring.
107
00:10:53,063 --> 00:10:58,556
So we have dozens of health systems are working with us today with our technology.
108
00:10:58,556 --> 00:11:11,503
Now in the ACCESS model, which is Withings delivering care for hypertension,
prediabetes, high cholesterol, obesity, ASCVD, the CKM spectrum.
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The way we're approaching this is integration back to the traditional healthcare
system is not a nice to have, it's a must have.
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Now we're leveraging those EHR integrations that we have with health systems on
remote monitoring, but we're doing it now for care coordination.
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00:11:29,078 --> 00:11:35,063
And how do we define in scope of what Withings is delivering care on?
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00:11:35,063 --> 00:11:41,722
So, you know, those are things like getting labs and managing medications, all with
the purpose of
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00:11:41,722 --> 00:11:44,643
let's have this patient be on guideline-directed care.
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00:11:44,643 --> 00:11:49,494
There's nothing new under the sun here when it comes to managing the spectrum of
conditions.
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00:11:49,494 --> 00:11:59,736
What is new is how technology can enable it to touch more patients and how clinical
variability when it comes to getting patients on guideline-directed care can be more
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00:11:59,736 --> 00:12:00,796
seamless.
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00:12:00,797 --> 00:12:11,354
So we're integrating back with PCPs, we're, as CMS would call it, co-managing
patients, and it's been a really interesting new layer of care.
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because we were going through credentialing for another payer and it was, are you
primary care, specialty care, urgent care?
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We're like, we're none of the above.
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We're something new.
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We're a technology-based care provider that is there to integrate back to the health
system, integrate back with the PCP.
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It's a different layer of care.
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I'm curious, Eddie, because you see so much on the other side, right, on the health
system side.
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You know, when you think about these expansive
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CMMI models like ACCESS, which are different than the more condition specific ones,
how do you kind of think about that from your lens?
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Yeah.
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I think for for us we're kind of building the ship as we sail it with these models.
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And I think that's the most important thing to understand is we actually get to
architect a way to work together and set up these systems from the ground up.
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I think one of the hardest things in healthcare is ripping out existing
infrastructure to input new ones.
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I think this is the chance and I think that's what
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CMS and CMMI have been doing that's so brilliant is starting afresh.
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So we can actually
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architect the system of our dreams as if you will, you know, as we move forward.
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And that means that we get to define these relationships from the ground up.
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where do we find that we want data to flow?
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Where do we find we want actual care delivery and services to go?
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And how do we get closer and closer?
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Where the patient already is.
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So from our lens, we think
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it's mostly about how can you create a unique experience for every patient.
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And it's almost less about everyone else.
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we spend a lot of time with health systems, and I think that you know the best thing
to deliver patient satisfaction, quality of outcomes, and cost management is
actually to
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interact with the patient.
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only as much as you need to.
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That's so interesting, right?
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you'd
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think that if you wanted to be really responsive, you spend much more time with the
patient.
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Actually, patients want you to only be there for as much as they need you.
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if they're doing fine and they can manage it with, some of the devices and stuff,
for example, you all provide, I actually think that's the win is you can actually
manage the
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outcomes that the patient cares about, the clinicians care about.
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and what Medicare as the payer cares about by actually engaging a little bit less,
but at the right moments, at the right time with the right data, so that you're not
recreating
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and you're only engaging at the points that create that value.
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So it really is about with the evolution of AI and where it is today, I think we can
actually manage this sort of
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as you alluded to a long-promised dream of value-based care, that we can actually
personalize it.
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And that leads me to my next question for you, which is how are you all leveraging
AI?
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and how do you think it drives the patient outcomes and experience that are so core
to clearly what you all provide?
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Yeah,
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and it segues, it's a good segue from what you mentioned earlier about the
experience and engaging the patient at the right time.
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In my past, one of the things I've both loved about value-based care, but
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have seen friction is the clinical care models that are developed by organizations,
whether in health systems or technology-based organizations, are in a vacuum very
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effective.
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they have, there's no mission without margin.
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In a vacuum, they work.
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What doesn't always work is does a patient want to be a part of this?
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And
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How do you handle these multiple taping of pieces together, especially hardware
pieces that are required for CKM conditions?
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What's happening here is the patient is always a consumer, and there's this huge
interest going on in healthcare around the use of wearables, the use of at-home
devices for...
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self-management, understanding oneself better, and that's where we're meeting the
patient where they are.
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So, Withings has this long consumer history.
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We have over 15 million users around the world, 5 million users in the US, almost a
million are 65 plus, and we're starting the relationship with the patient with,
want, the
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patient wants, the consumer wants to know more about themselves.
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Let's start with that entry point.
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Here is a...
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a scale that can measure your body composition that can do a lot more.
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Here's a blood pressure monitor that can do a lot more.
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And we start with that relationship and we can deliver medical care on top of that.
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Where we're integrating AI is how do we automate all the administrative tasks, and
I'm sure you're well familiar with all this, that increase the cost without
improving the
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outcomes.
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you know, getting a patient onboarded,
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is a set of administrative tasks that don't improve the outcomes, but are
requirements for us to just deliver care.
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So we've applied a lot of AI there.
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And now what we're looking at is how do we start applying AI so that that promise we
make to that patient, right, of you're going to understand more about yourself with
these
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devices and all of our markers are FDA cleared.
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We're applying AI to help surface information, help drive insight.
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to the patient.
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We're developing AI right now, and it's been very exciting.
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How do we help our clinicians and our clinical team, our nurse practitioners,
clinical pharmacists, also supervised by medical directors, how do we help our
clinicians be able to
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digest and make sense of all this data that's coming in?
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So patients have two, three devices.
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And know when is the right time?
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When is the opportune time?
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to make a medical decision.
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So we're very big right now on AI as enabling better decisions.
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We're big believers in how this technology is going to grow and be more powerful.
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But every decision at the end of the day is going to be made by a clinician.
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Every decision is going to be made by a patient.
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We're just using AI to make that process more seamless and also surface the right
information at the right time.
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And that's been so effective already.
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We had testimonial from one patient who was at the
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ACCESS launch event, who defined it as, this is a new way of, this is a new
healthcare system that is more proactive and responsive to my needs.
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And that really stuck with me, because if we can do this in the home environment,
and we integrate it back into the broader healthcare setting, which we're doing,
that means the
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whole healthcare system becomes more proactive and responsive to the needs.
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So we're taking this step by step,
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But I'm curious because you are dealing with AI all the time as well.
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I'm curious about how you're thinking about this technology and its applicability in
value-based care.
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well, thanks for inviting me into the AI discussion.
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for us,
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it's, we have a privilege of working alongside brilliant folks like yourself who are
on the front lines in the same way, right?
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Like collecting the data and being there with the patient.
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And we get to see it across different specialized verticals, across several service
lines.
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And we also then get to see that information and how it needs to get used within for
Rainfall Health.
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We do it as episode care management.
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So that means it's always time bound in areas and windows that are most impactful to
the patient journey, right?
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30 days post surgery,
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90 days post-surgery.
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There's a lot of data that shows that if we can manage patients in that time period.
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We actually really improve their long-term viability and long-term care and
outcomes.
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And so for us, it's all about taking data that's coming from all these different
sources and actually giving it a standard.
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And and by that, it's not dissimilar from your approach of taking data streams, but
the way we define standards is what it means in terms of quality.
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for the clinicians across different geographies, across different timelines, across
different episodes.
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And the AI piece for us is trying to both translate some of that stuff to the
clinician so that they know the action
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steps that are needed.
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And again, we're big proponents of always keeping the patient and the clinician at
the center of everything that's happening.
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And from the patient perspective, being able to meet them in terms of where they
already are and translating what's happening to them.
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And by that I mean we have our AI voice caller that speaks 76 different languages
that can help the
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patient just navigate what's happening to them.
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So that so they know all the possibilities of what to do.
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And that usually means that.
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Any patient might see as many as a dozen different care providers in that 30 day
episode.
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But from the patient perspective, there's sort of like one advocate, one touch point
for them that can help navigate through that entire piece.
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And for Rainfall, it's really about enabling other folks to shine, right?
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Whether it's hardware.
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combined with software like Withings or it's, you know, somebody just on a pure
services side or even brick and mortar like skilled nursing
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facilities.
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It's really about the patient flowing through the system and making sure that they
are in a great place overall and tracking it in terms of those components that I
mentioned,
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which is patient satisfaction, which is just as important as quality of care.
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which is just as important as outcomes and cost management, because you can't really
have all three working, you have to have all three working in unison.
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You can't really be taking one or the other out of the equation.
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so that's at least how we tend to view it.
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That's really, that's great.
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You one of the use cases I'm very obsessed with right now that
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And again, we have the benefit of having millions of consumers working with us and
tremendous amount of data is we've been able to develop and we had a publication in
the
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Mayo Clinic recently about predicting GLP-1 outcomes based on early, early data
points that we collect with our body composition scale.
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And that's been something that we've shown to our clinicians, like, is this
something of clinical value?
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And it's been incredibly instructive, not just for clinicians to be able to assess
titration schedules, but also the patient feels way more at the center of what
they're
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doing, which is kind of just on what Rainfall, right?
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The patient is a consumer and we've, historically, we haven't done a great job of
bringing that standard experience that a consumer would expect to healthcare.
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So what we're seeing here is that now the patients are able to see, how is my weight
loss going to project?
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And they're making better decisions.
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They feel more informed about their own health.
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And it's been helping us achieve better outcomes.
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So there's so much that can be done.
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And it really starts with, is this going to be part of a patient-centered goal?
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We have clinical outcomes targets.
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We have patient-centered goal targets.
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Is this part of a patient-centered goal target?
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is something that we can safely use, which is another big part you spoke on, too you
know, the, you're, dealing with, and in Rainfall, you're working with well-approved,
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well-respected medical providers and devices.
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Withings, we take a similar approach here, but on the device side, we're big on FDA
clearance.
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So any data that is coming back to our clinicians, they can safely act on it.
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And I think that's another piece that we're looking at a lot right now, which is
consumers are very interested in what's going on devices.
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Most of them are not FDA cleared devices.
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They're wellness devices.
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And that's a huge difference because a wellness device means, hey, and consumer or
patient, this is a wellness device.
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You can do with this what you wish, but there are risk associated and this is not.
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reviewed or approved by the FDA.
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And the patient has a very limited toolbox of what they can do.
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They can sleep better.
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They can maybe change their activity.
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When an FDA clearance comes in, now the toolbox expands.
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And it's no longer, hey, patient, here's what you can do.
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Now it's, hey, patient, here's what we can do together.
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We can put you on a second line therapy for your hypertension.
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We can titrate that medication based on this data point.
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So we're thinking a lot about this too.
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which is the AI is fantastic, what data is going into the AI so that when the
actions are occurring, we have the biggest toolbox possible in terms of actions
taken.
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Wow, that's such a differentiated approach in many ways where it you know, from
where we are standing and we spend a lot of time on these standards and you know,
folks that want
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to raise their hand and say, We're gonna go above and beyond the minimum
requirements.
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And that's what
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I'm hearing that Withings is trying to do and is doing successfully, which is going
to FDA when you don't necessarily need to, right?
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You'll still have the consumers, you'll still be able to get them
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even if it's a limited set of services, but you're going to FDA.
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You're raising your hand and saying, please judge us as a third party, do that
audit, because we feel so comfortable that we're willing to put our devices and our
technology
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for scrutiny.
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And that's such an amazing way to gain trust and also showcase why
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there's a differentiated space that you all can play in.
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And then that is
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truly what leads to being able to provide that better experience.
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Is that kind of how you all tend to also look at the strategy, which is like, hey,
look, we think we
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are delivering a better product and we wanna be able to showcase it.
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Absolutely.
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We've been, there's been this gray line, right, between the consumer and the patient
that's been, you know, as we've all been playing and understanding how do we make
this a
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strong
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integration between the consumer and the patient.
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And our belief is one of the big things is the data that is used by a consumer needs
to also be able to be used by a clinician.
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And the way to do that is through FDA approval, FDA review.
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That's a huge piece of what we think about.
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It also we have the benefit of thinking long term.
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So Withings is a large, but we're still founder-owned.
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company, we're a profitable company, we have a long term vision that we're trying to
execute on and we don't get distracted by the short term possible wins.
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We're thinking long term about how does an individual be able to prevent and manage
chronic conditions at home and our belief at the end of the day is enabling that
data
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point to be used by the person at home and by their clinician with the biggest set
of toolbox possible so they can
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manage their needs.
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we're always going to go above and beyond.
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We're going above and beyond by setting up our own medical group.
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We're going above and beyond because we think it's common sense that there should be
a continuity of care that goes from the in-person to the virtual into your home,
even into
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your bathroom scale that you stand on every morning.
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That's our core belief, and we're going to be focusing on that.
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That's so amazing.
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And, again, a differentiator approach, which does again come back to the core
foundings and how you all are set up.
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Now I'm going to switch gears just a little bit away from the patient because even
though that's such an important tenet of all care that we provide, to the clinician,
who's
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another,
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huge component of this.
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You mentioned you're working with multiple health systems, including MedStar.
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Who do you engage with at the system level?
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how because again, a lot of our audience are health system executives, and who are
the right folks that you would engage with that you get to showcase both the power
of what
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you're building and providing to the patient and also how you can probably make
their lives easier and deliver better care, right?
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Like that's always how we have these amazing executives who all care and want the
same goal, but sometimes
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You know, it's just so complex.
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So how do you how would you break it down on how you approach these different
systems and what does the value provide and to which leaders?
321
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we have fantastic relationships with our health system organizations working at
really two levels, the population health level as well as the virtual care and
digital health level.
322
00:30:42,531 --> 00:30:46,174
And we work with our partners in two ways.
323
00:30:46,174 --> 00:30:58,703
One way is, and like you mentioned, the 90 day episodes and the readmission windows,
we work with our partners a lot on heart failure, readmissions work.
324
00:30:58,703 --> 00:31:12,235
So, and one of the key reasons why we have a number of heart failure readmission
programs where we provide technology to our health system partners to be able to
have reductions
325
00:31:12,235 --> 00:31:16,458
of readmission rates is we do a couple things really well.
326
00:31:16,679 --> 00:31:20,423
One is we integrate data back very cleanly.
327
00:31:20,423 --> 00:31:25,847
Two is we've innovated device hardware and firmware.
328
00:31:26,001 --> 00:31:27,532
So we identified pain points.
329
00:31:27,532 --> 00:31:39,116
For example, in heart failure management, it's part of evidence-based guidelines to
collect not just weight, but also, and blood pressure, but also symptom surveys.
330
00:31:39,376 --> 00:31:50,780
And what we saw in the market with our partners was through their existing portals,
they would get 30, 35% adherence from their patients to these symptom surveys.
331
00:31:50,780 --> 00:31:55,122
And that lack of adherence means there's less visibility into the patient health,
which means
332
00:31:55,174 --> 00:31:56,554
higher readmission rates.
333
00:31:56,554 --> 00:32:05,917
What we've done, for example, is that we've designed our blood pressure monitor to
be able to, on the blood pressure monitor, believe it not, collect symptom surveys.
334
00:32:05,917 --> 00:32:10,678
The result of that is that we have an 89% adherence to symptom surveys.
335
00:32:10,678 --> 00:32:17,080
So we've been able to design hardware and firmware to meet the needs of specific use
cases.
336
00:32:17,080 --> 00:32:21,181
Heart failure is one of them, which is really big with population and virtual care
teams.
337
00:32:21,181 --> 00:32:23,622
The other one is hypertension management.
338
00:32:24,153 --> 00:32:37,664
For patients who are higher acuity hypertensive and polychronic and would benefit
from more integration with the healthcare system, we have on that blood pressure
monitor
339
00:32:37,664 --> 00:32:43,559
the ability to better educate on how to take a blood pressure reading.
340
00:32:43,559 --> 00:32:50,434
Also on the blood pressure monitor, we have the opportunity for patients to be able
to do automated retake.
341
00:32:50,434 --> 00:32:52,836
And these features are really interesting, Eddie, right?
342
00:32:53,092 --> 00:33:00,792
When we have our fee for service organizations who speak to us, they say, wow, this
is so efficient.
343
00:33:00,852 --> 00:33:05,832
That's horrible, because it's going to reduce our activity billing because we're
making fewer phone calls.
344
00:33:05,832 --> 00:33:14,072
When we have value based organizations who look at this feature, they say, this is
amazing because I'm going to save my clinicians time calling for retake.
345
00:33:14,072 --> 00:33:17,252
So we're thinking about these small pain points to make.
346
00:33:17,272 --> 00:33:23,237
virtual management more efficient and effective and that's been widely popular with
our health system partners.
347
00:33:23,237 --> 00:33:36,367
Now that we are doing lower acuity care ourselves, now we're working a lot more with
population health and virtual care, but through the way of how do we identify who's
eligible and
348
00:33:36,367 --> 00:33:39,429
who's really going to benefit from this type of program.
349
00:33:39,490 --> 00:33:44,264
But also for patients that we enroll that may not have known the system before,
right?
350
00:33:44,264 --> 00:33:47,446
Because we have 5 million users around the country.
351
00:33:47,544 --> 00:33:49,905
How do we get them back into the health system?
352
00:33:49,905 --> 00:33:53,577
If they need an echo, can we do a direct referral back?
353
00:33:53,577 --> 00:33:56,668
If they need a cardiology visit, can we do a direct referral back?
354
00:33:56,668 --> 00:34:06,872
So it's been a very exciting scope of partnerships and how we work with population
health and virtual care leaders.
355
00:34:07,773 --> 00:34:08,823
That's amazing.
356
00:34:08,823 --> 00:34:19,456
And, you know, again, really speaks to when you can align incentives from this sort
of policy lens, it really does drive the right outcomes
357
00:34:19,456 --> 00:34:29,899
and the right alignment across the entire network from patients all the way to the
payers, providers, clinicians, and everybody along the way to help make that happen.
358
00:34:29,899 --> 00:34:37,245
now, you know, as we start to think about all the data.
359
00:34:37,245 --> 00:34:41,818
that's being created and what are the insights that you're most excited about?
360
00:34:41,818 --> 00:34:52,833
What's, you know, that they'll help unlock now that we are able to start you know,
getting closer and closer the patient in the moment that we we have some sort of
insight
361
00:34:52,833 --> 00:34:58,787
to actually the care delivery, which some it sounds like some sometimes Withings can
provide.
362
00:34:58,787 --> 00:35:05,250
And then also going all the way to, you know, a specialized higher acuity care need
as well.
363
00:35:05,250 --> 00:35:07,121
What do you think it's going to unlock?
364
00:35:08,788 --> 00:35:11,108
It's a fantastic question.
365
00:35:11,349 --> 00:35:21,441
know, from at the end of the day, time to control for most of this population is,
think, all of our guiding principle.
366
00:35:21,441 --> 00:35:32,534
Now, readmissions are a very important metric, but it's a downstream effect of
getting a heart failure patient under control and stabilized.
367
00:35:32,594 --> 00:35:37,636
So we're always thinking about that component to it.
368
00:35:37,636 --> 00:35:38,936
What we see
369
00:35:39,128 --> 00:35:51,562
is when the patient is engaged in their own care, and our belief at Withings is that
the device is a core piece of that care that they get, and that data is helping
inform
370
00:35:51,562 --> 00:35:58,053
clinician decisions, we can accelerate time to control tremendously.
371
00:35:58,614 --> 00:36:07,606
The other piece of this, is as patients become more consumers and are thinking about
372
00:36:07,606 --> 00:36:09,837
What experience of care do they want?
373
00:36:10,117 --> 00:36:15,620
We're thinking a lot as well about patient satisfaction as being one of the core
pillars.
374
00:36:15,620 --> 00:36:20,463
Not just getting patients under control, but were they happy with the experience?
375
00:36:20,463 --> 00:36:25,145
Is that an experience that they are choosing with their feet, right?
376
00:36:25,145 --> 00:36:27,507
And to join.
377
00:36:27,507 --> 00:36:33,510
We waive co-pays and our partners often waive co-pays on things like this as well.
378
00:36:33,510 --> 00:36:37,872
But NPS is becoming more more important.
379
00:36:37,995 --> 00:36:43,636
One thing is our approach to that is we design a premium experience with our
devices.
380
00:36:43,636 --> 00:36:53,969
I don't know, Eddie, if you have, but it's a premium experience that we make
available to all income brackets, all lines of business.
381
00:36:53,969 --> 00:37:07,922
So much like we have our MedStar partnership in concierge medicine where patients in
those programs have resources to engage in higher touch care at MedStar.
382
00:37:07,934 --> 00:37:15,856
We also have FQHCs using the same technology for the same use cases, right, in the
Medicaid population.
383
00:37:16,016 --> 00:37:17,967
And that's been our guiding principle, right?
384
00:37:17,967 --> 00:37:30,301
So great data, FDA-cleared data to the patient, to the clinician, and an experience
that the patient is going to want to engage in, regardless of means to pay, is what
we are
385
00:37:30,301 --> 00:37:31,667
always thinking about here.
386
00:37:31,667 --> 00:37:35,002
And we've seen that with high activation rates.
387
00:37:35,002 --> 00:37:35,848
So...
388
00:37:35,848 --> 00:37:44,563
When a patient signs up, historically in my life, I've seen a number of programs
where even when they want to sign up, they don't start the program because once they
sign up,
389
00:37:44,563 --> 00:37:47,084
they're kind of like, what am I getting myself into?
390
00:37:47,084 --> 00:37:55,869
At Withings, 94% of those who enroll in our partners programs, hypertension and
heart failure, start the program.
391
00:37:55,869 --> 00:37:57,290
They are collecting data.
392
00:37:57,290 --> 00:38:05,094
92% engage month over month in a clinically meaningful way.
393
00:38:05,128 --> 00:38:17,088
and over 90% still use their device at the end of 12 months, that enables a much
more effective care model that the patient is gonna come back to the system and is
gonna come
394
00:38:17,088 --> 00:38:23,228
back and feel like they're being heard and that they're gonna want more support,
more services from that system.
395
00:38:23,228 --> 00:38:32,988
So that's how we think about it a lot, Eddie, is get the outcomes but do it in a way
that the patient experience is also top of mind.
396
00:38:33,990 --> 00:38:34,940
No, that's amazing.
397
00:38:34,940 --> 00:38:39,352
And such an again, an amazing way to look at the entire experience.
398
00:38:39,352 --> 00:38:47,754
It's if you listen to any of the other episodes of our podcast, I really talk a lot
about my personal mission around access to care.
399
00:38:47,754 --> 00:38:59,567
And I think that's fundamentally what you all are driving towards with experience
also still front of mind, but access so that we can make it more available to the
people who
400
00:38:59,567 --> 00:39:00,938
need it the most as well.
401
00:39:00,938 --> 00:39:02,650
that's
402
00:39:02,650 --> 00:39:03,401
so powerful.
403
00:39:03,401 --> 00:39:06,255
I it's it making me feel like I'm missing out on something.
404
00:39:06,255 --> 00:39:12,642
I'm gonna I'm gonna have to go to Withings and try to see what what I can get for
myself and find out more about my own data.
405
00:39:12,703 --> 00:39:14,216
maybe we'll
406
00:39:14,216 --> 00:39:14,958
going to be possible.
407
00:39:14,958 --> 00:39:24,515
The more and more payers are going to start covering for these types of ACCESS
services, we'll all be eligible for these, not just original Medicare.
408
00:39:24,515 --> 00:39:31,798
And I think the difference between remote monitoring with health systems and this
ACCESS model is worth speaking about too.
409
00:39:31,798 --> 00:39:36,180
So I think it touches on what is
410
00:39:36,819 --> 00:39:42,963
how integrated or sorry, how tied to the hospital should this patient be?
411
00:39:43,424 --> 00:39:51,148
For a patient that's coming out, they have multiple hospitalizations, multiple ED
visits, remote monitoring is gonna be the best way to do this.
412
00:39:51,148 --> 00:39:57,832
We want really small patient panels, very closely tied to that discharging hospital.
413
00:39:58,093 --> 00:40:05,957
And for patients who may not have an ED visit or an acute event, but like many of
us,
414
00:40:06,504 --> 00:40:21,317
going down the risk spectrum from obesity into hypertension to diabetes, ACCESS
becomes a fantastic service to have more preventive healthcare at a very low cost
structure that is
415
00:40:21,317 --> 00:40:22,658
no copay to patients.
416
00:40:22,658 --> 00:40:34,638
So I think also the type of access to care is being kind more formalized, which has
been very, very clarifying on the Withings side.
417
00:40:35,637 --> 00:40:36,958
No, that's so exciting.
418
00:40:36,958 --> 00:40:40,030
And I I'm excited to see where it keeps going.
419
00:40:40,030 --> 00:40:50,096
And it's it's great to see these enablement models instead of, you know, the
responses that have come out in the past, which is not yet another model.
420
00:40:50,257 --> 00:40:50,947
so it's great
421
00:40:50,947 --> 00:40:56,519
the ones that actually get to the heart of what we're trying to achieve have from
that like larger vision.
422
00:40:56,519 --> 00:41:04,764
as we start to think about, you know, wrapping up this incredibly exciting podcast,
and I could keep talking about this for hours.
423
00:41:04,796 --> 00:41:10,384
what are you most optimistic about in the next three to five years?
424
00:41:12,708 --> 00:41:13,828
I
425
00:41:14,969 --> 00:41:28,737
think we're on a path right now where technology-based companies like Withings, who
are both entering healthcare or enabling, and Withings we do both,
426
00:41:28,737 --> 00:41:39,630
We enable through remote monitoring, we go directly to patients for lower acuity,
are now having a more meaningful seat at the table of value-based care.
427
00:41:39,630 --> 00:41:52,614
whereas I felt a stagnation in this transformation that we've been part of since the
mid 2010s, now I see this reinvigoration of the value-based care movement
428
00:41:52,614 --> 00:41:56,805
because technology companies are having a seat at the table.
429
00:41:58,139 --> 00:41:59,690
not overlapping.
430
00:41:59,690 --> 00:42:09,137
So we are not, we are focused on the outcomes and we partner with our organizations
who are focused on the cost of care, quality measures, utilization based.
431
00:42:09,137 --> 00:42:13,359
But because we have our own seat at the table now, so much more can be done.
432
00:42:13,359 --> 00:42:25,197
And what that so much more can be done, I think of things like, you know, our
ability to predict GLP-1 outcomes, our ability to predict heart failure congestion,
it allows us to
433
00:42:25,197 --> 00:42:27,829
really invest a lot more into
434
00:42:27,837 --> 00:42:38,485
not just the individual biomarkers, but that overall AI sensing layer about what do
these FDA approved markers mean, so we can be more proactive in care.
435
00:42:38,485 --> 00:42:45,740
And that's really enabled because we have a seat at the table now, because now we
can safely invest into these technologies.
436
00:42:45,740 --> 00:42:54,316
And we've seen it already in the past nine months to a year, what we can build once
there's clarity about our role in the value-based care movement.
437
00:42:54,316 --> 00:42:56,817
So that's been very exciting.
438
00:42:57,116 --> 00:43:08,681
I don't want to say what's going to happen in three to five years, but I think there
are ways for us to be able to really bend the cost curve on chronic conditions.
439
00:43:08,681 --> 00:43:17,395
And I think there are ways that we can get everyone engaged in some preventive
healthcare, most notably hypertension.
440
00:43:17,395 --> 00:43:22,003
I think in three to five years, the idea of having, you
441
00:43:22,003 --> 00:43:33,183
Over 40, 50% of hypertensive uncontrolled, I think it's gonna look a little bit
crazy in three to five years once people all have the technology to monitor and the
access to care
442
00:43:33,183 --> 00:43:36,263
to properly treat a condition like hypertension.
443
00:43:37,648 --> 00:43:39,772
I feel like that's the future I can get behind.
444
00:43:40,837 --> 00:43:46,882
Patrick, what have we not talked about that you won't that we want to cover before
we wrap up today?
445
00:43:48,338 --> 00:43:50,979
I think this was an amazing conversation, Eddie.
446
00:43:50,979 --> 00:43:53,119
It's refreshing to speak with you.
447
00:43:53,119 --> 00:43:54,859
It's great to see you again.
448
00:43:55,399 --> 00:43:59,459
I would love to hear from your perspective, right?
449
00:43:59,459 --> 00:44:02,939
Because you deal in lot of episode-based models.
450
00:44:02,939 --> 00:44:06,819
One of the things about ACCESS is it's a longitudinal-based model.
451
00:44:07,279 --> 00:44:16,891
Maybe we can talk about this over coffee another time, but the way the overlap of
episode-based models and longitudinal models and...
452
00:44:16,891 --> 00:44:23,609
I'd love to hear more from you about what you think about that, but that could be a
separate conversation altogether.
453
00:44:24,176 --> 00:44:26,156
Well, it's good for us to tease it here.
454
00:44:26,156 --> 00:44:38,924
I think just on a high level, I just wanna leave that's a good place to leave
everybody, which is I think there is so much space and so much white space actually
for us to build
455
00:44:38,924 --> 00:44:45,067
on in both areas and drive better value, both in the short term where we see
456
00:44:45,196 --> 00:44:54,160
an acute event that's taking place and how to manage that versus really how do you
manage a better life.
457
00:44:54,160 --> 00:44:55,121
as a whole.
458
00:44:55,121 --> 00:45:01,708
And I think both of those have the same goal, but they're just driving at different
459
00:45:01,708 --> 00:45:02,267
stages.
460
00:45:02,267 --> 00:45:06,150
And I think the value is spread out over time.
461
00:45:06,150 --> 00:45:20,002
It's it reminds me of when there was a big literature finding back again in the
early 2010s that said only about 30% of your care and your outcomes are dependent
462
00:45:20,002 --> 00:45:22,424
on clinical information.
463
00:45:22,446 --> 00:45:23,877
The rest of it happens at the home.
464
00:45:23,877 --> 00:45:25,288
It happens in social settings.
465
00:45:25,288 --> 00:45:27,180
It happens in everything else.
466
00:45:27,360 --> 00:45:33,866
And what was always amazing to me about that is we only capture that 30% on the
clinical side.
467
00:45:33,866 --> 00:45:45,386
And now with technologies that are coming out, I think we have that ability to
stretch that into that remaining 70% and strive for that overarching goal that we
may never get to
468
00:45:45,386 --> 00:45:46,307
of a hundred percent.
469
00:45:46,307 --> 00:45:47,678
But hey, that's that's
470
00:45:47,678 --> 00:45:50,350
the frontier that we keep striving towards.
471
00:45:51,458 --> 00:45:52,058
I love it.
472
00:45:52,058 --> 00:46:00,041
Yeah, I think the if I think about ACCESS V2 right in 2027, 2028, I think this
473
00:46:00,047 --> 00:46:06,927
know, this integration between episode-based models and this longitudinal model is
going to be really exciting.
474
00:46:07,087 --> 00:46:11,807
And what does it mean for a transition of care back into the home environment?
475
00:46:12,247 --> 00:46:20,227
I think it's a point that we're going to be thinking about, and it's going to be a
really exciting time on this.
476
00:46:20,227 --> 00:46:23,307
So thank you very much, Eddie, for having me on here.
477
00:46:23,307 --> 00:46:28,927
And I look forward to diving deeper with you over coffee another time as well.
478
00:46:29,530 --> 00:46:31,659
Patrick, thanks so much for coming on.
