Join Megan Antonelli, the host of Digital Health Talks, and Bill Snyder, CEO of Cylinder Health, for a discussion of how digestive health impacts workplace productivity and healthcare costs. Learn how digital health solutions are transforming GI care delivery, improving health equity, and supporting return-to-office transitions while addressing the $136B annual burden of GI-related healthcare expenses.
Bill Snyder, CEO, Cylinder Health
Megan Antonelli, Chief Executive Officer, HealthIMPACT Live
Welcome 0:01 Welcome to Digital Health talks. Each week we meet with 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.
Megan Antonelli 0:30 Hi. This is Megan Antonelli. Welcome to Digital Health Talks. Today. We're tackling a critical but often overlooked aspect of workplace health, digestive wellness. We're joined by Bill Snyder, CEO of cylinder, who's leading the charge in transforming how companies support gi health through digital innovation, with GI related healthcare costs reaching 136 billion annually. This conversation couldn't be more timely. Hi, Bill.How are you?
Bill Snyder 0:59 I'm well, Megan, thanks so much for having me on today. Yeah, I'm so
Megan Antonelli 1:02 glad you could be here and tell us a little bit about cylinder, but first, tell us a little bit about you know, your background and how you got there.
Bill Snyder 1:08 Yeah, absolutely. So I've always been in healthcare. I spent over a decade at Humana in various leadership positions, and that gave me some really good insight into the inner workings of the healthcare ecosystem. And from there, I also always knew I wanted to build something. So I had been spending weekends and evenings working on different entrepreneurial projects, and I left Humana to go to an early stage company in the diabetes space. And then from there, I founded cylinder in 2021 with a mission to revolutionize digital health gut first. And that was born out of seeing loved ones and friends suffer from chronic digestive conditions and watching them really struggle in terms of where they can go to get real help. Mm, hmm,
Megan Antonelli 1:56 yeah, it is, you know, it's one of those things, having having kids. You know, it's like, my stomach hurts and there's nothing you can do. You're like, you're like, Okay, I guess you're gonna stay home again today. That's right. You know, as a, you know, as a woman and getting older, I'm feeling it too, and I know, you know, so many people suffer from it. Tell it. Tell me a little bit about, you know, the population you guys serve, and you know, where you're seeing, you know, providing a lot of value. Yeah,
Bill Snyder 2:28 I think people are normally surprised to hear kind of the scope of this problem. And so 40% of Americans suffer some type of GI distress. About 25% of those are considered chronic digestive conditions. So that's things like ulcerative colitis, Crohn's disease, irritable bowel syndrome, Gerd and a host of other conditions. So you've got this large population that is diagnosed with all these chronic conditions. You also have another large population who are suffering in silence, so they're symptomatic with things like chronic constipation, chronic gas, bloating, abdominal pain, and they don't really know where to go. They're not sure, am I supposed to go to a primary care physician for this? Do I need to see a specialist? Oftentimes they're ending up in the emergency room. And so we know it's a problem that's really large in scope, and we also know there are conditions that are difficult to diagnose and difficult to treat. So at cylinder, we work with large self funded employers and with health plans across the country to help support their members by providing them incredible care.
Megan Antonelli 3:26 Wow, yeah, about how many patients are using the tool now.
Bill Snyder 3:33 So we've worked with over 85,000 patients. We are actively treating patients across the country, in every state, so we've got really broad membership that we support today.
Megan Antonelli 3:44 And in that, I imagine you're seeing, you know, certain trends, certain data. Are there certain things that are, you know, that you would say would really around either productivity or healthcare costs that would really surprise
Bill Snyder 3:56 folks? Yeah, I think couple of the trends that we're seeing, we're definitely seeing an increase in the number of these conditions from a percentage perspective. And so I think when you look at the American diet, when you think about the food that we're eating, it's not surprising. I mean, we hear it anecdotally, right? More allergies. We started off by talking about kids, you know, more allergies and and definitely earlier diagnoses of a lot of these conditions. And so we see it from a percentage in the American population as well, the percent with these conditions continue to rise. And then we also see really high engagement rates in our solution. So when we have access to a population, we're seeing a high rate of those opt in to our program compared to other chronic condition solutions. So I think it's we see it in the consumer demand, and that's also mirrored by what you see out in the world today. I mean, you walk into a food store and you see all these gut healthy solutions, and in you turn on Netflix and you see gut health. Documentaries. If you go on Tiktok, you see a lot of information on gut health. So from a consumer perspective, we're definitely seeing that need and demand from patients across the country,
Megan Antonelli 5:11 yeah, and they are, you know, it's particularly hard to diagnose. I mean, I know from my own experiences, and you know, certainly with friends, with with kids and adults with celiac and IBD, and, you know, a lot of them represent differently and all of that. So tell me a little bit around, you know, kind of that being a, you know, digital platform, how that is different from, you know, obviously, to some degree, just the access, the wait times, you know, do you go? You know, it's, it's like, that decision to go to the emergency room because you have a stomach ache versus, how bad does it have to be, right? I mean, it's like, I, you know, like, unless it's appendicitis, you don't go, you know. But tell us a little bit about that, you know, how the model works, and what that, that experience looks like. Yeah,
Bill Snyder 5:59 I think, I think you hit it on the head in terms of what their traditional care delivery in this area kind of looked like and felt like for the patient. You know, oftentimes people aren't sure where to go, so they're going to Google. They're going to try and figure out, hey, what am I supposed to do with this? I've got abdominal pain. I've got, you know, bloating and gas. I'm not sure if this is just something that I can take some over the counter medication for or should I be going to the emergency room? And the way that shows up in terms of utilization patterns across the US is the fact that these are a leading cause for emergency room admissions across the country. It's always one or two. Abdominal pain is right there, and the underlying issue tends to be digestive health related. And then we also see a lot of kind of meandering through the healthcare ecosystem. So patients going to see maybe a primary care physician, and that primary care physician is doing everything in their power to help the patient. You know, they're doing everything right, but the truth is, there's no singular test. There's no biomarker that says, hey, this is how this patient is doing. And so oftentimes they'll go through a series of tests, they may be referred to a specialist. There is a shortage of gastroenterologists across the US right now, so wait times are really long. So now that patient continues to suffer, continues to wait to get into a gastroenterologist, and then same story. We've got these great gastroenterologists across the country who are trying to do everything possible for these patients, but they are overburdened, and they don't have as much time to spend with the patient. And oftentimes those tests, you know, we talk to patients who have been scoped multiple times, and there's nothing conclusive, you know, the good news is they're not finding anything. The bad news is the patient is still suffering post visit. So for us, when, when we built cylinder, our mission was to provide evidence based care that was simple, that was immediate for members, that connected them via a technology platform to a care pathway that was personalized based on their need. And then they were supported by a remote care team made up of health coaches, registered dietitians, gastroenterologists and internal medicine specialists, so we could identify the root symptom and the root cause, and then with those great brick and mortar providers as well. Because we do need things like we do need patients going in to get appropriately scoped. And so we see ourselves as an opportunity to to help the patients up front and early on, and then also to connect them to the right care in the field as well. Yeah, that's
Megan Antonelli 8:19 great. I mean, because I do, I think that access issue is such a big one. And as you said, you know, where, where the diagnosis fits, you know. And often they, you do the tests and they don't, it doesn't come back. So needing that kind of constant, you know, sort of interaction with a health coach, you know, really helps. And there's, you know, in terms of just what even impacts it or affects it. Tell me a little bit about, you know, as you're talking to the employers and the payers around this, you know, why does the digital side of this, you know? Why does that appeal to them so much? And is it, is it the employers or the health plans or the consumers more that the digital element and what's unique about that brings value?
Bill Snyder 9:01 Yeah, I think for the consumers, the health plans and the employers, they all see the value in the digital first solution, and the value that I think that they're seeing is, number one, incredible consumer experience. So again, making sure that the patient is heard, that we're personalizing that experience, and that we're giving them access to care very quickly. The second thing that we look at is our outcomes. So first, are we creating that magical experience for the patient? Two, are we achieving great clinical outcomes? And for us, we've been able to prove that at scale. So we've published a series of papers that have been able to show the mitigation and symptoms patients feeling better. So decreasing that pain, decreasing things that are not even somewhat related to digestive health, but expand behind beyond the GI field, so things like reduction in stress, reduction in anxiety, and then the third component for us is financial savings for the member and for the plan sponsor. And so we have been able to show that we decrease hard costs as well things like reduction emerging. Room visits, reduction in those duplicative doctor visits that we talked about, and even things like improved medication adherence for the patients that we work with. So I think when we go back to those three things that patient experience, those great clinical outcomes, and patients feeling better, and then the cost savings we're able to achieve for plan sponsors and patients, those are really the three things that I think differentiate us, and the reason that we've had so much success in the market, and
Megan Antonelli 10:23 are you, is it a solution for pediatrics too, or are you mostly focused on adult population? It's only
Bill Snyder 10:29 for adults today. I would love to get into the pediatric population because there's a significant need, and I felt that personally with my family. So we would love to move into the pediatrics at some point, but currently we're only working with 18 and above.
Megan Antonelli 10:42 Yeah, we'll get there. But, but in terms of that access issue, I mean, obviously with kids, it is, it is that much more challenging to diagnose and to manage, because it is the gut health, brain connection is all there, for sure. But as you look at the larger populations, in terms of your Medicaid population, and those who get, you know, sort of, it's harder to access specialist care. Are you? Are you having traction in that space as well? Or, you know, what is your sort of, if you will, equity, you know, value play there absolutely
Bill Snyder 11:20 so we have a big plan to expand into that area. And we actually just published a study that showed the impact that we have for individuals who are higher in the social vulnerability index is actually outsized relative to the impact we have on patients not on the higher end of that that index. So we know that we can really serve those that we can we can help underserved populations in pretty meaningful way. So that's really exciting for us. From a contracting perspective, we have not expanded into the Medicaid or the dual eligible population yet, but through our partnerships with our health plans, we think there's a big opportunity to do so in the upcoming years. Yeah,
Megan Antonelli 11:58 tell me a little bit more about the study, though, in terms of, you know what was, what was the nature of the questions and the areas where you felt like you could have the most impact.
Bill Snyder 12:08 So for that particular study, and we've done a bunch of different publications, so that's something that's part of our DNA, and something that we're pretty committed to. And so that particular study was looking at clinical outcomes and financial outcomes in a social, socially vulnerable population. And so we're looking at that by condition and by symptom category, and showing mitigation of symptoms improved clinical outcomes, and then improved overall patient experience, where we achieved all those outsized outcomes relative to the base population. And
Megan Antonelli 12:38 do you have in terms of, you know, sort of that holistic sort of approach, you know, in that often this is a nutritional issue, or it could be a food you know, you know, food issue, you know, whatever the Where do the connections with primary care versus, you know, other specialists or needs for that come in, like, dieticians all of that,
Bill Snyder 13:03 yeah. So I think for us, what we've focused on is we want to make sure that there's not silo treatment for these members. And to your point, sometimes that the requirement there is an engaged provider, sometimes it's a registered dietitian, sometimes it's a health coach. And so for us, we create a coordinated care system where all of our care team members are able to see the journey for the member. And then what we're doing with our technology is optimizing the triage process so being able to bring that member to the right care at the right time. Because today, I might need a session with my registered dietitian, but I may have a flare up, or I may have a question about the medication that I've just been prescribed by my doctor, and a consult with a gastroenterologist might be really valuable for me as the member. And so we want to wrap those members with a coordinated care team through our platform, and then we also want to share that information out to any providers in the field that are supporting with and working with that member as well. Because, to your point, we know digestive health is highly correlated to all these other conditions. Your digestive health impacts diabetes, it impacts cancer, it impacts mental health. You mentioned the bi directional referral patterns between the gut and the brain. You know those are very real, and so we know that the work that we're doing is going to impact the overall health of the member, and so we may want to make sure that we're not siloing it by any type of condition, and instead including any care team member that's touching that member along their journey.
Megan Antonelli 14:33 Yeah, and I think that's one of the we talk about it a lot, in terms of just with all of these solutions that are, you know, so needed, and they're they're supporting, they're filling the gap where the access problems really exist in this country, in doing so what we don't want to do is silo the care more. So it seems like cylinder is really doing a great job of keeping that, you know, sort of holistic approach, even though it's filling that specialty gap. If you will. That's absolutely
Bill Snyder 15:00 right. We do bi directional referrals to other providers today and other solutions. So we are finding patients. You know, we we had a story from a patient that we worked with, this was earlier this year, where that patient was not going in to get a scope done, and they were of the age and with a family history where the clinical guidelines were recommended that she should be going in to get that scope done, and she was rightfully nervous about it. She was scared. So she had put this off for years, and our team kind of walked her through what she should expect and really promoted her going to get this care, and actually helped her find a provider in the area to get her colonoscopy completed. And she they did ultimately find something, and she was diagnosed with Stage Two colorectal cancer, which is, which is, you know, our team, it was a big impact for our team, you know, because that's, that's obviously a pretty big patient journey, but that's part of you know, the value is making sure people get that right care and go in to see their brick and mortar providers to your point, not breaking down, not putting up silos, but breaking those down instead, and making sure that patients are accessing not only the care that cylinder provides, but the other care around them through the healthcare ecosystem,
Megan Antonelli 16:19 right? And that CO that coaching and consistent engagement that can be provided through these sort of digital platforms that just can't be supported. I mean, they just can't, I mean, we can, you know, we can hardly support, you know, emergent care, you know, let alone these touch points where people need coaching just to get to the health system, you know, for that sort of basic level of care. So that's really great. Tell me a little bit in terms of, I know another study you guys did around the state of gut health with the workplace survey. Tell me some of the findings from there. Yeah,
Bill Snyder 16:52 we did this survey and surveyed members from across the country, and found a lot of really interesting findings. And so this was understanding, this was this particular survey was focused on individuals who are suffering from chronic digestive conditions and or symptoms, and gaining their reflection and insight in how that affects their ability to to work, to do their jobs. And there was a lot of great findings in there. I think you know, two of the primary ones that stood out were 72% of the respondents said that they were less productive at work because of their digestive condition andor symptom, and 59% said that they had missed work because of their digestive symptom andor condition. So when you think about your workforce, you know one of the things that we always want to do is show the impact that we can have on the patient experience, show the clinical outcomes and show the hard cost savings that we're achieving for our members and for their plan sponsors. But productivity is real and and we do see it impact these patients in a very meaningful way. And so that survey was helpful for us to hear, but it was we've gotten some really nice accolades from the employer market to say, hey, this, this helps me understand how this is truly impacting our teams these conditions.
Megan Antonelli 18:11 Yeah, I was, I mean, as I did, did my research for our conversation, and looking at cylinder and seeing that, you know, it is going through the pairs and the employers. Because, of course, I was going to sign up immediately because, you know, had GI issues to deal with, but there's but you know, in terms of serving that employer market and showing them the value and seeing the value in that, you know, and the workplace, of course, has changed so much, and so many, so many work from home, and we've been able to work from home for a while, and in doing so, that actually opens, you know, being able to work from home if you do have chronic issues that sometimes that that helps. But now, of course, we're seeing a lot of return to office and, you know, transitions like that. Are you seeing, you know, sort of an uptick or a need or interest from from employers. What are the what's their kind of perspective on that and all that? Yeah, we are.
Bill Snyder 19:09 We're definitely seeing an uptick of interest and need from employers and from health plans. I mean, I think that the focus on this area has grown very quickly, and so we're seeing a lot of market demand. You mentioned the return to office for a lot of folks and and we definitely see the angst associated with that. For patients with these conditions, it's it's tough to talk about. You know, these are conditions that oftentimes require access to that the bathroom. And you know, when we talk to our members, we hear about the stress and the anxiety. And the anxiety. And for anybody who's ever suffered from these conditions, that's very real. And so people are talking about, you know, where their new office or new seat in the building is positioned relative to bathroom. I mean, those are some of the considerations. So so that is very real. And so for us, we want to be there to support the members that are going through that. Journey, because oftentimes they don't have anywhere else to go or turn to in these conversations. Is
Megan Antonelli 20:05 it, and are you able to have that kind of dialog with employers too, to help them support patients with these diseases and conditions we are,
Bill Snyder 20:15 I think what we're seeing is a greater recognition, and I think, you know, a little bit more empathy towards these conditions that maybe aren't so visible and and so I think more. And the reality is bull know it because they or their loved ones are experiencing it. And so when we go into a conversation, start talking about what it is that we do, we get a lot of nodding heads, and a lot of people come up after and say, Hey, listen, I've been on my own digestive health journey. Or, hey, my spouse, my loved one, my child, has been through this, and I understand how grueling it can be. And so I think we've, we've been, you know, it's been the silver lining, as we've seen a lot of empathy from employers, and I think again, that's based on their unique perspective as well.
Megan Antonelli 21:02 Yeah, and when it comes to, you know, real everything we talk a lot about, you know, you mentioned evidence based, you know, digital medicine and kind of the return on investment are you, you know, what are some of the metrics that, you know, specifically, the the employers really care about? I mean, obviously, return to work or not return to work day, you know, days, productivity, days and that. But are there specific ones that you think employers should be looking at, or that they are asking you for that, you know, you find interesting?
Bill Snyder 21:32 I think the employers do a great job of this because, you know, the professionals that work in the total rewards in the Human Resources space, they have a lot on their plate, and I think that they tend to be very educated buyers of solutions like ours, and that's great because they are asking the right questions. They're looking for validated outcomes. They're looking for peer reviewed publications. They're looking for proof that you can create an incredible experience, proof that you can create great clinical outcomes, and then proof that you can reduce the cost of health care. I mean, cost of health care continue to rise for all of us. There's no silver bullet. And so I think it's really important that if you're a new digital health solution, that you need to be going out with those publications with those proof points and the ability to put fees at risk. You know, we put performance guarantees on every partnership that we do, and we guarantee savings, we guarantee clinical outcomes, we guarantee great experience for the members that we serve. And so I think from the employer and health plan side, it's great to see then demand those things, because I think any digital health solution should be able to provide them, right? Yeah,
Megan Antonelli 22:40 no, absolutely. And in, in that, you know, when I followed the the sort of workplace benefit space for a long time, and in health and and, you know, it's interesting, because it kind of ebbs and flows, right? I feel like about 10 years ago or so, there was a very large, you know, sort of the large, self funded employers that were really taking an active, you know, role in, kind of managing health care. And then it kind of faded a little bit, but it seems to be picking up again in that, you know, and maybe that's because costs are rising, or because employees are demanding it. As you look at that workplace health benefit space, what are some of the, you know, interesting trends that you're seeing broadly and and with respect to digital health, I'm sorry, digestive health, yeah, I think,
Bill Snyder 23:25 I think broadly, going back to the previous question about the proof points and what organizations are looking for, I think more and more there they are looking for those proof points. You know, you need to show that you're having an impact. You need to be able to prove it. I think that especially during the COVID timeframe, there's probably a lot of solutions that were being rolled out, and some of those work really well. Some of them maybe not as well. And so I think that the employer market is demanding, hey, look, you need to show that there's a return on investment here, that you're taking care of our people, that you're making care better, that the access is improving, that the costs are going down. And so we definitely see that kind of active role being taken by by our partners, which is great. And then, and then, I think, on your point, on kind of the broader macro trends, you know, we're definitely seeing, I think, one big macro trend, two big macro trends that we're seeing across the healthcare industry. Number one is GLP ones, and certainly the number one side effect there is digestive health issues. So from a help and support perspective that we can provide, we're talking to a lot of members today that are on GLP ones, and you know, we can support them in their journey by looking to mitigate those symptoms, to make sure they're staying adherent to their medication. And then we're licensed to practice medical nutritional therapy in every state, so we have registered dieticians that are their training is rooted in long term, sustainable behavior change. So you think of that combination of supporting members on this journey, and we think that we're. Positioned really well to help support those members for the long term. Yeah, and then the second piece there is AI in healthcare, you know, that's the other one that so many people are talking about. And I do believe that there's some really exciting things that are happening in AI. And I know for us, we're thinking about, how do we make our back room more efficient so allow our practitioners to still be the ones delivering care, but now we can look at all this longitudinal data and leverage pattern recognition to say, hey, we understand the journey of these members, and in these cases, here's the most up to date clinical guidance that we would provide, and then have our care team ultimately say, Yes, that makes sense, and that's what we're going to deploy in terms of this clinical care journey. Or no, I'd like to adjust this real time, and so that just allows our care team to be more efficient and more effective. So we see that as a big opportunity for us going forward.
Megan Antonelli 25:55 That's great. Yeah, I mean to the GLP one discussion, and certainly the side effects and often, I mean, many GI symptoms and conditions end up being side effects of drugs that people are on, right? I mean, whether it's, you know, chemotherapy or GLP ones or a note, a host of other drugs that have gastro impact, so you know, and that, I think, is what makes it so important, that cylinder has that sort of connection to the rest of the, you know, the primary care and the other doc, so that that's great, you know. And I am, and I can only imagine what the number of folks on GOP ones and growing that that will be a huge, you know, audience and a group of members for you to serve. Absolutely,
Bill Snyder 26:45 yep, and we're, we're excited and happy to support those individuals along their journey.
Megan Antonelli 26:53 Yeah. In terms of, we always, you know, as we close and we have a few minutes left, talk about kind of, what would you fix? You know, what's, where's one of the areas where you know, you've gotten into this, you've been in healthcare a long time, on the payer side, and now really the provider side, you know, what's the, what's the one thing that you know sort of says, Oh, God, I wish this would change in healthcare and, or, or that this was easier.
Bill Snyder 27:21 I think the biggest thing would be the age old problem of interoperability. You know, we do bi directional referrals for patients today, we talked about breaking down silos, and we do our best in that work, and that's something that's very important to us at cylinder. But the truth is, just in the US healthcare system. There's so much more to do in terms of data sharing and coordinating care amongst different providers, and so I think that is still an issue, and there's still a ton of work to be done there, for
Megan Antonelli 27:56 sure. Yeah, I know it is critical, and I think to make that you know those connections happen, both for the patients to access their data, but for the providers to be able to share the data and know what's going on, especially with the number of different sort of point care solutions. It's only becoming more important, more important. Luckily, Mickey Tripathy and his team are working on it hard with all their stuff, but it is, for sure. So that's a good one. And then as you look to you talked a little bit about, you know, AI and the connections there, and certainly GLP ones being kind of an exciting area where people are managing their health on a broader level, though possibly having some side effects in the, you know, as you look at what's the most exciting thing, we like to talk about the good things in healthcare, what's what's your most What are you most excited about? As you look to the future of healthcare,
Bill Snyder 28:49 I'm really excited about technology in general. In healthcare. I think that technology can play an outsized role when I think about how care is delivered traditionally, and I think about the support that we need for all caregivers out in the field, for us as healthcare consumers, I think that we're just at the beginning stage of seeing what technology can do to help improve care, deliver efficient care, and provide access to the most vulnerable populations, to really life changing solutions. So I'm very bullish on what technology can do for improving our health across the country. Yeah,
Megan Antonelli 29:24 it's amazing. I mean, it really has been, you know, this so slow for so long, but, you know, recently, it just feels like some of the things are clicking and moving in the right direction. And certainly a lot of these amazing tools that are providing, you know, care and in places where the access gaps are pretty dramatic, you know, are really making an impact on patients lives, and it's great to see
Bill Snyder 29:50 absolutely well.
Megan Antonelli 29:51 Thank you so much for joining us. Tell our audience where they can contact you or get in touch with cylinder, yeah,
Bill Snyder 29:56 so please check out our website. It's www dot. Cylinder health.com Come check out what we're doing. And if you're looking for support as a employer or a health plan or just health, please reach out to us. Connect with us. We'd love to, love to have a conversation with you about what we're doing. Awesome.
Megan Antonelli 30:16 Well, thanks, Bill, thanks so much for sharing your insights and telling us all about cylinder and the work you've been doing. You know, it's very it's great to see, you know, such effort to revolutionize gi care and workplace wellness. So really important stuff. And to our listeners, as we've heard today, addressing digestive health is crucial for both employee well being and business success. Join us next week for an episode of digital health talks as we continue to explore innovations shaping the future of healthcare,
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