Discover the transformative journey of Rheumission's Founder and Chief Patient Officer as they delve into the motivations behind transitioning from autoimmune patient advocacy to pioneering a virtual Integrative Rheumatology clinic. Gain insights into Rheumission's innovative approach to personalized autoimmune care, driven by data-driven research and development, and learn how holistic support encompassing nutrition, sleep, exercise, and mental health services is poised to revolutionize the landscape of autoimmune care. Explore the role of integrative medicine within rheumatology and how Rheumission aims to seamlessly integrate traditional treatments with complementary approaches, while addressing the anticipated challenges of delivering virtual healthcare and ensuring accessibility and quality for patients worldwide, regardless of geographical or socioeconomic barriers.
[00:00:00] VO: Welcome to Digital Health talks. Each week, we meet with the healthcare leaders making an immeasurable difference in equity, access and quality. Hear about what tech is worth investing in and what isn't. As we focus on the innovations that deliver. Join Megan Antonelli, Janae sharp and Shahid Shah for a weekly no BS deep dive on what's really making an impact in healthcare.
[00:00:23] Megan Antonelli: Hi everyone. Welcome to health impacts, digital health talks. This is Megan Antonelli, and I'm here today with Dr Bonnie philman, co founder and chief patient officer at Rheumission. I've known Bonnie a long time. It's exciting to have you here. Hi, Bonnie. How are you
[00:00:45] Bonnie Feldman: Great Megan, delighted to be here. Thank you so much for allowing me to participate
[00:00:51] Megan Antonelli: Absolutely. Well, you know we are all about female founders here being one myself and when I saw that you had launched Rheumission. I was so excited to have you on the show. So tell us a little bit about Rheumission and your inspiration and what it does.
[00:01:09] Bonnie Feldman: I'd love to we are super proud of Rheumission, and we have now launched. I founded Rheumission as a one stop shop with a multidisciplinary team to better serve autoimmune patients like myself, my family, including my two son in laws and my 10 grandkids, who have a double dose of these genes. After decades of being an autoimmune patient, myself with a convoluted patient journey, like most of the other stories we have heard, I was just fed up. I was waiting for someone to reimagine autoimmune care, and then finally, that someone needed to be me, and what I longed for was a holistic solution that would bring the best of conventional and lifestyle medicine and deliver it through a tech enabled platform. I didn't really know how that was going to look, but when I set out to build it. I met Doctor Yu, who is our integrative rheumatologist, triple boarded in conventional lifestyle and functional medicine, and I was so excited to find someone like him with this huge toolkit, that I kind of took it as a sign from up above that this was supposed to happen. And I proceeded to recruit a lifestyle medicine physician, and now we have an entire team that includes a psychologist to address the anxiety and depression that is often overlooked in autoimmune patients the exercise issues. We have an exercise program. We have a care coordinator, and most importantly, we have a dietitian who she's a registered dietitian with an expertise in autoimmune food plans, and that is really important to our holistic approach to lifestyle medicine and rheumatology.
[00:02:58] Megan Antonelli: Well, that's amazing. And oh my god, 10 grandchildren. That is amazing. I, you know, knew you long before that, and congratulations on on that, because that is quite an accomplishment.
[00:03:09] Bonnie Feldman: 10 grandchildren is and and I want to inspire all the older women out there, because candidly, we are venture funded. We have a seed round from Takeda digital ventures, and it's how shall we say, I am not your stereotypical entrepreneur. I'm smaller in stature. I am much older. There is no slot for a short, little woman with 10 grandchildren. They had to be super imaginative in that regard. And so we are grateful to have the opportunity to seed this idea and launch the product which has gotten initial feedback from the patients, which has been very encouraging and positive.
[00:03:52] Megan Antonelli: Well, that's great, you know. I mean, maybe we'll just have to get you a Patagonia vest, just to, you know, feel a little bit bigger, but I think it's fabulous, and kudos to Takeda for making the investment, you know. And I think you know, as you said, that that holistic approach is so important, so, and there's been a lot, you know, we work with node health, and we work with a lot of the you know, over the years about the evidence and the value and the research that goes into this. So tell us a little bit about the R and D process around Rheumission's approach.
[00:04:26] Bonnie Feldman: So research is near and dear to my heart. Many people probably don't know this, but I have what's called deep curiosity, and I'm a lifelong learner. It kind of began when I was a kid, and I can't even believe this, but at eight, I asked my mother, what was inside a frog, and what did she do to that curious question, she ordered me frogs to dissect in the basement. Now I have to say none of my grandchildren have done that yet, but looking at their array of interests, and as I reflect to my own childhood, I can see that that deep seated care. Curiosity is with me today. In fact, as an equity research analyst that is all about research that is all about curiosity on the business side, looking at hundreds and hundreds of healthcare companies, and I was nicknamed the due diligence Hound Dog, because no matter what I found out, I needed to find out more. And I applied this over a decade in autoimmune disease, when I was first a patient advocate, and in the patient advocate world, most of the patients, I was a different kind of patient advocate, because I was advocating for autoimmune disease as an investment opportunity. So I was helping investors to understand the size of the market. It began when I first did Digital Health Consulting for cancer companies. And I went to the autoimmune companies. I went to them and said, Why can't you do autoimmune and they said, the market is too small. And I said, No, no, you're wrong. The market is actually really large, because if you seg, it's currently segmented by body part, but when you add up all the individual diseases, unfortunately, it's a large and growing market. Most recently, there have been many publications that have validated this original research that really took place a decade ago. And the more important research to form the ideas around Rheumission came from my 500 patient interviews over a decade. So we've done extensive speaking to patients about their patient journey, about their pain points and at Rheumission, I am technically called the chief patient officer, and as the chief patient officer, once again, I have to thank our board who allowed me to have a three pronged approach. One of them is constant patient research. We are always talking to patient iterating the product. We have a patient feedback program based in research, because we want them to tell us the good, the bad and the ugly. And I'm also if there's any listeners out there in the process of putting together what we're calling a patient advisory council that will be a strategic board that will help me as the chief patient officer, to get input from a patient perspective on areas of expertise that they may have, technology issues that we have, user design, experience, marketing, whatever other skills they can bring in addition to their patient or lived experience. So that's the basis of our research and our current patient first strategy,
[00:07:39] Megan Antonelli: Great, yeah. Well, bringing the patient into it is so important. And I think the, you know, in terms of providing that holistic support, right? I mean, I think the thing with that people don't necessarily understand, and as you said, that they that it impacts several different areas of the body and and they, you know, depending on what disease you have, and, and disorder and, and in terms of the holistic approach to that, right? So tell me a little bit about, and that's where, I mean, I know what? My mom had, rheumatoid arthritis, and she, you know, went through many, many medications. Some work, some didn't. Some caused multiple other issues, right? So they're tough medicines to take in a lot of cases, and they cause other problems. But then there's the nutrition and the sleep and the exercise and the things that are much more, you know, within the patient's control, but harder to often harder to do than taking the pill or the shot or getting the infusion. So tell me a little bit about how Rheumission is going to support that
[00:08:42] Bonnie Feldman: love too. It began when I was a patient in conventional medicine and autoimmune disease, as I said, is segmented by body part. So most of these patient journeys, including my own, include multiple visits to specialists. If you have a skin problem, you see a dermatologist, you see an endocrinologist, a rheumatologist, a gastroenterologist, when really the entire body is connected. Your mind is connected to your body, and rheumatology in particular, your joint pain is connected to both your mind, your mindset, your stress level, your sleep patterns, your exercise so when I was a patient, I had to put together my own team by becoming the CEO of my own health seeing a conventional rheumatologist, going first my personal experience was in functional medicine and Then going to physical therapy and lots of different exercise modalities that I call movement therapy. And in dreaming about Rheumission, we wanted a one stop shop. And Dr Yu, the rheumatologist and his wife, Dr Melissa mandala, who is our lifestyle medicine doctor, all. Already had established a program in their private practice that looks similar but different, to Rheumission. In their private practice, they function. I'll just, I mean, they have what I'll call integrative rheumatology. Lifestyle Medicine is the first line of defense. We believe in medications such as biologics, but it is not the first line of defense. The first line of defense is the whole body integrated into lifestyle medicine, using food as medicine with the support of a dietitian. That is how Rheumission works, too. And in their private practice, they actually have an evidence base that shows a remission rate of up to 60% using this modality, and some of it includes drugs, and some of it doesn't. But we're it's a combination approach. So based upon that experience, we have built even more into our one stop shop, we are dealing with the anxiety and depression that associates that is associated with many of these diseases by having a psychologist as part of our team, we acknowledge it, and it is super important in doing 500 patient interviews, whenever I say, oh, you know, you know that anxiety and depression is often associated with these diseases. See if you can guess the most common answer I get.
[00:11:28] Megan Antonelli: Is it a chicken and the egg question, does the depression come first or after? Or
[00:11:33] Bonnie Feldman: sometimes I get that. More often than not, I get Yeah, I have that, and no one's ever asked me, Well, sure. Or sometimes I get, yeah, they sent me to a psychiatrist and I'm on antidepressants, but it's really not helping enough, right? So, I
[00:11:49] Megan Antonelli: mean, and often is it? Sometimes the first line of diagnosis, right? I mean, it's like, I know as a, you know, as women going through changes, and there's pains and there's aches and there's joints, and then, you know, the first thing is, well, you know, how's your sleep? And are you depressed? You know, so a lot of time that's the first line, right,
[00:12:10] Bonnie Feldman: correct. So we're going to deal with that head on, and we're going to have a psychologist. So how the program works is, patients see Doctor, you our integrative rheumatologist, and then they go to the lifestyle medicine sort of side of this, where they are supported by a registered dietitian, lifestyle medicine doctor, a psychologist and an exercise program. We also have a care coordinator to make our one stop shop more patient friendly. It is a program that is everything that I wanted to find for myself that I couldn't. And so far, our patients have said things like, this is the best thing I have ever experienced in medicine. I love the convenience of having it all in one place. And they've said things like, it's really important to look at the big picture of me, because the program is also not cookie cutter. What I have found in my autoimmune diseases that were undiagnosed for years is that every person's body is different. Every person's body responds differently to stress. The definition of stress changes from body to body, and in my case, it changes with age and level of disease. So how do you develop a program that takes all that into account? This is truly personalized, and it is one to one, and there is no there is no one size fits all, and each of our custom programs is designed for that particular patient.
[00:13:54] Megan Antonelli: Got it. So how many patients are do you have enrolled in the program? Now?
[00:13:57] Bonnie Feldman: We have about a dozen awesome
[00:14:01] Megan Antonelli: and then interesting. How, how does it scale? Right? So, is there, you know, sort of the access or the growth, or just more more staff, or, you know, tell me a little bit about the platform and how that works.
[00:14:17] Bonnie Feldman: Sure we have, we are led by Dean Sawyer, our CEO, who has a track record of five successful startups. And as a seed stage startup, you can't do everything at once. We have very disciplined approach to our growth, and it goes like this. We're going to have a dual strategy, direct to consumer. That's what we have now. The largest growth will come from the transition from fee for service to value based care, starting with our first type of insurance pilot study to prove our outcomes. After that, we will scale the model very similar to our sister company, oshi in terms of expanding to. States expanding to more value based care contracts and probably expanding to more diseases.
[00:15:07] Megan Antonelli: Oh, amazing. So tell me a little bit. We've talked a few to a few folks this week about, you know, value based care and there's been some discussion online. And I think coming out of all the events that that have been happening. I think it was I saw from the health evolution event last week, and they had a session that was sort of like, is, is value based care here to stay, you know? And it's like we've been talking about that for a lot, a long time. So tell me a little bit about what that look what does the value based care structure for Rheumission look like in terms of the contract instead,
[00:15:43] Bonnie Feldman: I can't give too many details, because number one, we're really early, and candidly, we don't know exactly in the big picture. In fee for service, only parts of our program are reimbursable. In other words, the physician visits are reimbursable. The dietician may or may not be reimbursable in fee for service in our original model, coaching is not reimbursable. So the advantage from our perspective, and from a patient's perspective, is to have a bundled payment so that there is one price to include all of these services. That's our big picture goal. How that will actually be translated into a contract? I'm not sure that is not my area of expertise, but the big picture is that you will be able to bundle these services and have one price to include all of these visits. The patients now have many visits. I mean, it's a very in, you know, intensive program, they're seeing the rheumatologist, they're seeing the lifestyle medicine, they're seeing the psychologist, they're seeing the dietitian, they're seeing the exercise program. That's quite a large number of visits. And in fee for service, it would not be feasible,
[00:17:04] Megan Antonelli: right and now, are is some of this? Is it a combination? Is it hybrid? I mean, are there virtual visits and and in person visits? What you know, how much of it is virtual versus in person right
[00:17:16] Bonnie Feldman: now, it is all virtual. We do have plans in the future to have partnerships for hybrid activity some. One of the, one of the questions we get from many patients is, can you really do a virtual rheumatology visit? Because patients think, well, I have a red, swollen joint. How are they going to look at it and see it? And, you know, that's, that's a great question during covid, many rheumatologists learned how to do virtual visits, and Dr Yu has been doing virtual visits before even covid. So the answer is for the three diseases that we are currently treating, which is rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis that involve joint pain, we feel very confident that we can do those virtually. And there has been conventional medicine validation of virtual visits, mostly coming out of covid. The other underlying theme is there's a tremendous shortage of rhematologists, and the current tremendous shortage is expected to grow exponentially, so that a when you interview patients, a common complaint is, if they live in a rural area that's a rheumatology desert, they have no options. If they live in a city where there are rheumatologists, most of them have closed practices. So although there are options, the waiting time is three to six months. I mean, for example, my own brother in law, who lived in Chicago, saw Dr Yoo because he couldn't get a timely appointment with his brick and mortar rheumatologist. And he was very impressed that Dr you was able to make his diagnosis.
[00:19:04] Megan Antonelli: Yes, even in Chicago. And now here comes my senior dog coming in to have, you know, he's probably feeling his arthritis as he jumps on the chair. But, yeah, no, that is, I mean, I think that that's, I mean, it is. There's a certain intensity to the treatments right where, if you are getting medication that you need to go in, but also the support of what's necessary, where you would be going, you know, going in, but that, but also because of the debilitating, you know, pain often having to go in, so as much as you can alleviate that for the patients, all the better. And of course, the access issue is huge. So being able to support them is is big. So, you know, I mean, what a what an amazing solution and offering in terms of, you know, for the patients. So given your experience, you know, in in patient advocacy and. Thing as an and as a long time entrepreneur in the space and consulting with entrepreneurs, tell me a little bit about, you know, your challenges, and you know you mentioned the getting funding and the trajectory for you know, where you see, you know, Rheumission, finding, finding its its footing and growth and and scale for that
[00:20:21] Bonnie Feldman: Sure. Over the years as a patient advocate, I've watched myself and other get poor results from conventional medicine that only focuses on medicines, and this leads to negative side effects and actually a much higher cost for autoimmune patients to the system at large. So we want to actually give patients a better experience, a one stop shop, a comprehensive approach to rheumatology, and also save the payers money, which we believe we will be able to do. We are following in the footsteps of our sister company, oshi in the GI space, who is further along and has already proved the value and has multiple value based care types contracts and has expanded nationwide. So our approach is very similar. Our goal is to be a natural a national, virtual, first value based care practice where patients don't have to wait three to eight months to see a rheumatologist where they can quickly have access to one in a new and different and improved one stop, virtual, integrative rheumatology approach that fills their physical, mental and emotional needs. So we want to do that for the patients. We want to save the payers money, and the challenges that we face are balancing the business needs with the patient needs, and that is exactly what we are trying to do
[00:21:50] Megan Antonelli: amazing Well, I think you're on a very good path to doing that. I think you know it isn't it's certainly not easy, but getting getting there and getting the funding in those initial stages. So congratulations, and with you, I'm so excited as a topic near and dear to my heart, and I'm happy to you know, excited to hear more about it. As you guys continue to grow,
[00:22:16] Bonnie Feldman: I it is very hard to get a seed stage, startup off the ground, and I wake up every morning and look at a picture of my 10 grandchildren to imagine and visualize what is really important, and that is to leave A legacy of prevention for autoimmune patients.
[00:22:42] Megan Antonelli: Yeah, no doubt, I think that that is so important, and that holistic approach that you're taking is really, you know, so meaningful and important in this in this space. Thank you. And you know, tell us. Tell us where we can find you, where people can get more information.
[00:22:57] Bonnie Feldman: Rheumission.com. Www, com, and as the chief patient officer, you can contact me directly, bonnie@Rheumission.com and I also talk to patients. You can call me, and that's on my email.
[00:23:20] Megan Antonelli: Awesome. Well, thank you so much, Bonnie. I appreciate it, and thank you to our listeners. Reach out to Bonnie. We'd love to get your questions and make any connections we can. Thanks. Thank you.
[00:23:37] VO: Thank you for joining us for this week's health impacts digital health talk. Don't miss another podcast. Subscribe@digitalhealthtalks.com and to join us at our next face to face event. Visit Health Impact live.com you.