Personalized Support for Medication Adherence with Sebastian Seiguer, CEO and co-founder of Scene Health

[00:00:00] Hey everybody, welcome back to the Outcomes Rocket. Super excited that you joined us today

[00:00:08] because I am privileged to have Sebastian Seger on the podcast. He is the chief executive officer

[00:00:15] and co-founder of Seeing Health, previously at MoCA, a med engagement company that provides

[00:00:21] personalized breakthrough medication support by combining video technology, clinical coaching,

[00:00:27] and validated interventions to radically improve medication adherence rate. In 2014, Sebastian

[00:00:35] spun seeing out of Johns Hopkins University with Dr. Bob Bollinger and other medication

[00:00:41] adherence experts to help communities served by public health departments, health plans,

[00:00:45] including Medicare and Medicaid, and health systems. So we're excited to have him on to talk

[00:00:50] about the work that he's done. And so with that, Sebastian, welcome to the podcast. So

[00:00:56] glad you could join us. Thank you so much for having me, Saul. Appreciate it. Of course. So look,

[00:01:00] we're going to have time to dive in the scene and the work that you guys do. But before we do,

[00:01:06] tell us a little bit about you. What got you into the healthcare business?

[00:01:10] Yeah, so I'm a Baltimore native. And I grew up here, end up in law school in New York City.

[00:01:18] And my first job out of this is a long roundabout way to, but I'll get to it. But

[00:01:22] first job out of law school was in London. They were sending me over to a customer

[00:01:27] in Munich, Germany. So I was going over to Munich, Germany, and I ended up starting a coffee chain

[00:01:32] in Munich. You did? Yes. Yes. And I grew up. Well, my law school buddies were doing internet

[00:01:39] businesses. This was 1999. And this was the best thing I could think of. It was a boom in Europe

[00:01:44] right at that time, mostly in the UK hadn't got to Germany. So I figured I'd set up a

[00:01:47] coffee chain there. I grew it to about 25 locations. It took a lot longer than I thought it would.

[00:01:53] But here's the point that I created what I thought was a wonderful product. But I was just not,

[00:02:00] I really felt that it was not fulfilling to just be selling product. My parents were physicians.

[00:02:07] My wife is an infectious disease doc, same with my sister. And I just love the motivation

[00:02:12] that they get every single day by doing something that is helpful to other people.

[00:02:17] And so I wanted to combine the entrepreneurship and business with creating

[00:02:22] something of value to communities and to other people. And I ended up doing an MBA at Hopkins

[00:02:28] in healthcare after selling the coffee chain. Nice. Yes. And I realized that I was fascinated

[00:02:34] by adherence as a problem, being naive and not, you know, a healthcare professional at

[00:02:38] the time. This is now 2013. I thought, well, this is something I could understand. This is

[00:02:43] probably a behavioral issue partnered with some docs at Hopkins and set off on this journey.

[00:02:49] And it's been quite the learning experience. But the motivation comes from,

[00:02:53] I think adherence is a really good thing for my personality. I'm a bit impatient.

[00:02:57] I want a result. I want to see it now. And I want impact. And I want it now. So

[00:03:01] I looked at drug discovery opportunities. Maybe it'll work. Maybe. And your chances are low.

[00:03:07] I don't want maybes. I want to know right now that we can do something impactful

[00:03:12] because I want to go to bed at night proud of what I've been doing that whole day.

[00:03:16] And I think my team feels that way too. They like having this immediate impact that you can get

[00:03:20] by helping somebody take their medication correctly. Totally. And it's a huge problem

[00:03:25] in the US and the world. Something like 50% adherence is absurd. Hey, well, really interesting.

[00:03:33] So I love the copy chain. And okay, so a chain of 25 coffee places is not easy to do.

[00:03:41] I give you kudos for that and you sold it. So you got the exit there. You got the building of

[00:03:46] the business. You come into healthcare. And it's cool because when you're dealing with healthcare,

[00:03:52] a big part of what's missing is that consumer perspective. And it seems like you bring

[00:03:58] that in. So talk to us a little bit about maybe how you've infused some of that.

[00:04:02] But answering the question of how does seeing health add value to the ecosystem?

[00:04:07] Sure. So to understand what we do, as you said, taking medication is a problem. It is different

[00:04:13] in different cultures, but it is certainly in our culture and in our healthcare ecosystem.

[00:04:17] We have a lot of fragmentation of providers and facilities. It is a massive issue and people

[00:04:23] are very confused about it. The standard of care in a hospital is that every single dose

[00:04:28] is administered under something called directly observed therapy. Long story short, a nurse

[00:04:33] watches the patient take the medication and monitors the response. And that in the outpatient

[00:04:39] setting, that's only done in a few cases, methadone for addiction, tuberculosis medications

[00:04:44] in public health departments. So our goal was to create a digital delivery platform. This is back

[00:04:51] in 2014 when we spun out of Hopkins for directly observed therapy. So all video back

[00:04:56] and forth, all recordings. What do we do in end effect? Well, the physician has decided that this

[00:05:02] patient, whether it's chronic conditions, infectious conditions would benefit from a certain medication

[00:05:07] regimen. Unfortunately, a lot of things get in the way after that prescription, starting with

[00:05:11] whether they even picked it up, right? Our job is to make sure that those physician orders

[00:05:17] are actually fulfilled and that the patient actually takes the medication. And we do it by

[00:05:22] helping them at every step of the way with a video back and forth interaction to actually take

[00:05:27] meds for a certain amount of time. So the contribution is this ecosystem spends so much

[00:05:32] money producing medications, innovating on medications, one of the most innovative drug

[00:05:37] discovery, if not the most innovative drug discovery ecosystem in the world.

[00:05:42] However, when patients don't take medication correctly, we know it doesn't work right.

[00:05:47] And this whole continuum of care kind of breaks at that point. So our contribution is to help people,

[00:05:53] especially those who are in the most vulnerable situations, succeed on medication.

[00:05:58] I love that. And Sebastian, so are you guys still focused on those drugs that need to be taken

[00:06:04] under observation or have you expanded beyond those? The early days were all tuberculosis and

[00:06:09] for example, buprenorphine and methadone for addiction. But I think by about 2017,

[00:06:15] we already had peer reviewed publication showing that what we were doing was working.

[00:06:18] We moved into asthma first, and then showed that we could improve inhaler technique and adherence

[00:06:24] over a 90 day period, take it from about 30% in kids in West Baltimore up into the 80% as observed

[00:06:32] and correct inhaler technique, which is huge because if you don't take your asthma medications

[00:06:37] correctly, then they're not getting into your body, right? So at this point, and as we started

[00:06:42] to work with health plans, diabetes became important. We've worked with patients with

[00:06:47] hypertension, now sickle cell disease, solid organ transplant recipients and immunosuppressants.

[00:06:53] So the technique works across the board. You just have to have a way to motivate and engage

[00:06:57] the patient to start the program. Love it. Thanks for sharing that. So you guys have really

[00:07:02] expanded the drug types and are finding results across the spectrum there.

[00:07:08] How would you say what you do is different or better than other medication adherence programs

[00:07:14] and platforms out there? Unfortunately, when you hear medication adherence, you're thinking about

[00:07:20] whether people have picked up medication. And that's because maybe about a decade ago,

[00:07:24] the quality metric proportion of days covered became very big from CMS has instituted these

[00:07:31] metrics which guide health plan performance and their reimbursement dramatically.

[00:07:36] And it's all about getting medication into people's hands. So that's a real incredible thing.

[00:07:42] If people don't have medication and they get it, then of course now they have the opportunity to

[00:07:46] take it, but you've got a really expensive patient when they get their medication

[00:07:50] and don't take any of it. So the way we do things different is we use these words medication

[00:07:55] adherence. What we're talking about is did the patient take their medication as prescribed

[00:08:01] and correctly. And so the difference is it's a daily process. There are not many competitors

[00:08:06] directly going selling into health plans with a service like this because it's complicated.

[00:08:11] It's not just a technology. You need a care team to deliver this technology platform.

[00:08:16] So most of the direct competitors have gone into clinical trials where you have more of a

[00:08:21] mandated situation or into small clinical studies like the smart pill bottles and all

[00:08:27] the rest of those type of solutions. So this is more of a disease management approach in some

[00:08:31] ways. We're trying to get to a health outcome here. It's great if they take their medication.

[00:08:35] We want that, but we want to lower A1C, we want to lower costs and many adherence companies are

[00:08:40] focused on proportion of days covered and those quote unquote adherence metrics.

[00:08:45] Understood. Yeah. And that's a big difference, right? Tied strictly to the outcomes.

[00:08:49] Are they taking it? Are they taking it the way they should be?

[00:08:52] And as you think about, you guys have been doing this for 10 years now.

[00:08:57] What's been a setback you've experienced in a big learning that you feel has made the company

[00:09:02] that much stronger? Well, doing something like this is just a series of setbacks nonstop all

[00:09:09] the time. So that question is always a hard one, but it's a good one because it's always the

[00:09:15] setbacks that redefine the product, redefine the service to come to mind off the top of

[00:09:20] my head. Two like pivotal inflection points. The first was we were first just the technology,

[00:09:25] we didn't have a care team and in 2018 we implemented with a local Medicaid MCO here in

[00:09:30] Maryland as a software and it was just three or four days later they're like Sebastian. We loved it,

[00:09:36] it's as you promised, we're not watching these videos every day. We're not doing this.

[00:09:41] We can't engage at this pace like your playbook is telling us to. So we knew we had to create

[00:09:47] a virtual care team and we put together pharmacists, nurses and health coaches into what is today like

[00:09:53] the most wonderful team, the most compassionate team, but also the most expert in adherence.

[00:09:57] So that's probably a big one. And then I think a second one is what you just said now,

[00:10:02] you had said, okay, it's an outcome that they're taking their medication doing correctly.

[00:10:06] Actually, it was the realization that in health plans, that's not enough.

[00:10:11] Health plans, especially in Medicaid, were really surprised that we could engage patients

[00:10:15] and get them to take their medication. But as soon as we showed we could, the question was,

[00:10:19] so what? What's their A1C? What's their blood pressure? Once we solve that, then the next

[00:10:24] question was, and how much money are you actually saving here? Are you covering your costs? Are

[00:10:28] you producing an ROI? So I think the lesson is adherence is not enough. It's a great starting

[00:10:35] point, but you got to get the health outcome and you have to have a financial outcome and

[00:10:39] it's got to be fast. It's got to be fast, especially in Medicaid with all the churn,

[00:10:44] with all the redetermination things happening, you need a financial and a health outcome now.

[00:10:49] 90 days, 120 days, 180 days. And Sebastian, have you guys been able to prove that out?

[00:10:54] The economic outcomes as well? Yes. Yes, we have. It's been quite the process because

[00:11:01] claims data has complexity and it's also in Medicaid. It's not standardized across the

[00:11:06] country how these, how claims lie. As we know, data can be very, very messy. And

[00:11:11] we have like 25 peer reviewed publications in the provider setting where people's various

[00:11:17] conditions, they improve their adherence and their health outcome. In the health plan setting,

[00:11:22] you have rolling enrollments and the way you have to measure this is 12 months before,

[00:11:28] this is what we've come to, what was their cost 12 months before you initiated the program?

[00:11:33] What about 12 months after? So what we're talking about is if we're talking today

[00:11:37] about financial results, we're looking at people engaged in 2022. So there is some time

[00:11:43] and you need scale as well. It's not in our academic studies, we have statistically significant

[00:11:48] results with 50 people, 60 people, 100 people. In the health plan space, you need hundreds,

[00:11:54] thousands of people to detect the improvement. So it's not easy. We finally have it.

[00:12:01] I'm just thinking, man, like, okay, here is your adherence. Oh, well that's not enough.

[00:12:05] Give me the outcomes. Here are your outcomes. Oh, well that's not enough. Give me the money.

[00:12:10] And so it's just like, man, like one thing after another.

[00:12:13] It's a learning process though also for health plans. Health plans are also trying different

[00:12:18] things and learning as they go as well. And so we're kind of early days when it comes to

[00:12:22] health plan, patient engagement, let's say if you want to broadly call it that we would

[00:12:26] call it medication engagement. But yeah, and Sebastian, like kudos to you and the team for

[00:12:31] for sticking with it. And as the new hurdles pop up, you find ways to address them and add value.

[00:12:38] And certainly there's no question here that you guys are hitting the mark. What would you say

[00:12:43] today is a healthcare trend or technology that's going to change the game for medication adherence?

[00:12:49] I would say broader than medication adherence is this magical communication

[00:12:55] modality, which is it's strange that it's not used more. So we're communicating with the

[00:13:00] member primarily through video recordings. Okay, so the patient video records themselves,

[00:13:05] they say how they're feeling, they take their medication. The first couple weeks,

[00:13:09] it's about taking medication after that, it's about any saw you can't even believe what's

[00:13:13] being talked about. It's everything you can imagine from the Ravens, unfortunately today,

[00:13:19] to, you know, their dog to everything and the back and forth is personal, right? Our team,

[00:13:25] we can automate a lot of things, but we do not automate the return message back to the patient

[00:13:30] on video saying their name and responding to what they said in social media. Recorded video is the

[00:13:36] primary mechanism of communication right now, thinking snap Instagram, etc. I cannot believe it

[00:13:43] is not more utilized in this trend towards consumerization of healthcare, maybe because

[00:13:48] the back and forth requires a lot of workflow and information about the patient's health and

[00:13:53] context. So maybe it's just really hard to get it right. But wow, when you get it right,

[00:13:59] patients love that they can access healthcare in this easy way that you don't have the

[00:14:03] formalities of an appointment and don't have to be live for somebody. So it's pretty amazing.

[00:14:08] Yeah. A synchronous video is pretty cool. And Sebastian, who are they getting this video

[00:14:13] from? Is this white labeled? Is it coming from the plan from the provider from scene health?

[00:14:18] Tell us about that. It hasn't really been demanded to be white labeled today. In theory,

[00:14:23] you could, but most health plans or providers that use us, they want our brand and they want

[00:14:29] our care team to have a little bit of separation for various reasons. Although I will say with

[00:14:34] Care First in Maryland, we've started integrating their care teams videos into our video banks

[00:14:39] so that we can send a motivating message here and there or send certain information from the

[00:14:43] health plan over. Got it. That's really interesting. Love what you guys are doing, folks. There's

[00:14:49] opportunities here to take your medication engagement to the next level and beyond that.

[00:14:55] Right? We've learned from Sebastian that it's about outcomes and it's about cost too. You're

[00:14:59] going to include all those things. What closing thought would you leave us with,

[00:15:02] Sebastian, as we wrap up today and what's the best place listeners could reach out to you and

[00:15:07] the team to engage, to learn more? So as a closing thought, I probably should have

[00:15:12] mentioned this when you asked about inspiration, but this technique that we're using has been around

[00:15:16] for decades. So we were inspired really by Hopkins infectious disease professionals at

[00:15:22] Baltimore City Health Department. A very similar approach was used by Paul Farmer and there's

[00:15:27] a great documentary from Paul Farmer. The thought I would leave you with is that

[00:15:32] at the pop health level, you could talk about all the problems and everybody knows what

[00:15:35] they are. But at the individual level, you just don't know where you're going to get

[00:15:38] till you talk to that person. And you can't talk to them once. You've got to help them out for a

[00:15:41] little bit of time. It's a bit of a journey. The amazing thing, the magical thing about

[00:15:45] adherence is that it is daily and it is the best excuse to talk to somebody and therefore open

[00:15:52] up the conversation to the other issues that are ancillary but also really, really important.

[00:15:58] So I think medication adherence, true adherence is an untapped area where you can really

[00:16:04] drive the control of chronic condition on a daily basis. So I would encourage people to

[00:16:11] watch the Paul Farmer video. It's a great description of directly observed therapy

[00:16:15] and the magic of like helping somebody when they take their medication correctly,

[00:16:19] incredible things happen. So it's an untapped opportunity. You can learn more about us

[00:16:24] at www.scene.health. That'd be the best place and you can always reach out to our team at

[00:16:30] info.scene.health as well. Amazing, Sebastian. And thank you for having us on, Saul.

[00:16:36] Yeah, yeah. This is our pleasure. We appreciate the work that you and the team are doing at

[00:16:41] Scene Health and folks in the show notes as always will leave all the ways that Sebastian

[00:16:46] mentioned to get in touch with him and his team as well as a link to that farmer documentary.

[00:16:51] So we'll make sure you guys have all those resources there. Appreciate you guys tuning

[00:16:55] in. Sebastian, thanks for being with us. Thank you so much again. Take care.