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Transforming Obesity Care in the Digital Age
Originally Aired: https://virtual.healthimpactlive.com/...
As a highly accomplished physician executive with over 20 years of experience as a GI and bariatric surgeon, Dr. Aggarwal is uniquely positioned to discuss the intersection of medicine, surgery, and digital health in tackling the growing obesity crisis. During our discussion, we will explore how twenty30 health is leveraging technology, human health coaches, and complex data analysis to create personalized patient care journeys that drive high-value outcomes. Dr. Aggarwal will share his insights on the role of digital health solutions in improving access, engagement, and efficacy of obesity treatments, including the integration of GLP-1 medications into comprehensive care plans.
We will also delve into the challenges and opportunities of building and scaling digital health startups in the obesity space, drawing on Dr. Aggarwal's experience at Thomas Jefferson University's venture arm and his work with companies like Livongo and Neuroflow. The conversation will touch on the importance of clinical validation, user-centered design, and value-based care models in driving adoption and impact.
Rajesh Aggarwal, MD, PhD, Founder and CEO, Twenty30 Health
Megan Antonelli, Chief Executive Officer, HealthIMPACT
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[00:00:00] V/O: 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 Tech Talk.
eep dive on what's really making an impact in healthcare.
[00:00:31] Megan Antonelli: Welcome to Health Impact Live Digital Health Talks. I'm excited to welcome my friend, Dr. Raj Agarwal. Raj is a highly accomplished physician executive with over 20 years of experience as a frontline GI surgeon. Raj founded 2030 Health, where he serves as CEO, focused on delivering whole person value based metabolic and obesity care.
And Prior to that, he was chief growth and strategy officer at Panda Health, a digital marketplace. He also served, and when I met him, as executive vice president of Jefferson Strategic Ventures and professor of surgery at Thomas Jefferson University. With his entrepreneurial spirit and commitment to driving meaningful impact, we look forward to his insights.
Hi Raj. Thank you so much for being here today. It's so good to see you.
[00:01:21] Dr. Raj: Megan, as always, it's a pleasure. The only pity is that we're connecting virtually versus in person, but I know that's going to happen pretty soon. So I'm looking forward to it.
[00:01:29] Megan Antonelli: Yeah. I know. Me too. I don't think we've seen each other in person.
We've crossed paths so many times, but we haven't seen in person in a bit. In that time, there has certainly been some changes and you've launched 2030 Health and we've had a chance to talk about that. I'd love to hear from you kind of what your, what your drive to launch it was and what it's all about.
[00:01:49] Dr. Raj: Thank you. Megan. So let me just start with the name 2030 health and people say, well, what does that mean? Well, the year 2030, which is a publication back in 2019 of the new England journal of medicine, that's a year when it's projected there will be more people with obesity in the United States than without obesity.
So the obesity rates will be over 50 percent and it's also projected that by that time across the globe, 1 billion people will be dealing with obesity. And so really. The framing here is obesity is the disease of our time and why. Am I interested in obesity? Well, I've been a health system guy, a GI surgeon.
I've worked with, um, innovation technologies, med device, digital technologies for my whole career. We started the bariatric surgery practice back in London at Imperial College in 2006. I came over here to Philadelphia, where I'm still based, and I had a job at the University of Pennsylvania. Just over a decade ago, I started the adolescent bariatric practice with Children's Hospital of Philadelphia, did the first case in 2013.
A challenge here, I'm sure we'll get into this, is I started doing this surgery because I saw that there was a need and there was a massive impact and being an academic surgeon, I thought there's an opportunity to publish some of this as well, which was pretty exciting. And what I was told by some of my own colleagues, surgeon colleagues saying, Raj, you shouldn't be doing this surgery.
You should be spending your time doing cancer surgery. Or other surgery for people that really need it. When I started the program at CHARB, I was told, these kids should just be able to figure it out themselves. They should just be able to eat less and exercise more. And so, the stigma, the bias, the discrimination that exists with obesity and people who deal with it, that is such a massive area that we need to focus on versus when you think about someone with cancer or someone who needs a hip replacement.
And so, I started 20, 30 Health. I mean, I've been. Really thinking about this company for over 20 years and putting a lot of the clinical and the technology and innovation factors together, but we're just about a year and a half old and the approach is a obesity disease management plan. And what does that mean 1 is it's around access to healthcare.
So there's 110 million Americans right now that are dealing with obesity and less than 1 percent of them get appropriate medical care. Imagine if just 1 in 100 women with breast cancer were treated appropriately. That's a travesty. The second is the way we deal with obesity is very transaction. It's a low calorie diet.
It's an exercise program. It's a shot. It's a surgery. Now, that's me being a little bit flippant here. We do have comprehensive obesity disease management programs, but let me again, bring up an example. If you have a woman who's been diagnosed with breast cancer, would you ever say to her, do you want to choose between chemotherapy, surgery, or radiotherapy notions?
I want it all. I want whatever's going to work for me. And that way we don't do a great job. How do we put this together and say, what's right? For this individual may not be right for this individual, so a multimodal whole person comprehensive approach and you and I've talked for many years around digital health and the opportunities.
How is this underpinned by a technology platform, an app in the patient's hand, a web provider portal? We need to have a human high touch resource as well. So we also have health coaches. That support the individuals through this journey, because the individuals can get scared, can feel that they're not being heard.
And then the third piece around 2030 health is going beyond weight loss as a metric of success. When we talk about the amount of weight that's lost, it's an easy thing to measure. But what we really want to focus on is resolution of chronic disease, because we know a higher BMI or weight leads to type 2 diabetes, leads to heart disease, leads to osteoarthritis, leads to polycystic ovarian syndrome and infertility.
And having treated over 6, 000 patients in my clinical career, I've seen how we can really change lives. Yes, weight loss is an important process measure. But what's really important is how we can reduce that chronic disease burden. And now this goes from being more of a vanity drug to actually a miracle that can help treat multiple chronic diseases.
Let me pause there and um, uh, we can come back to more detail.
[00:06:26] Megan Antonelli: Well, there's so, there is so much that you said. I mean, and it is, you know, I know we've had the chance to talk about this and it is, you know, the stigma around, um, coverage and care. It, it's, it exists and I think we're seeing it play out in the media.
We're seeing it play out in doctor's offices. But when we met you were at Jefferson, I think, and you guys had started the Ventures Group and so working in that context, like let's talk a little bit about where this fits in, in that digital health. ecosystem, right? I mean, are you marketing to consumers?
Are you marketing to the health plans? Who's the, you know, kind of the vehicle get the access to 2030 health to the patient?
[00:07:12] Dr. Raj: I've already mentioned obesity. It really is the disease about time, not just in America, but around the world. So the simple and kind of upgrade answer is to everyone, right? But that's not the best way to start a business, right?
Or even to build a business. I'm a health system guy. I've spent my whole life in health systems. So I'm not a farmer guy, not a payer guy, health systems. The first thing I'll say, and then I'll come to Jefferson, but health systems are the most respected entities when you compare them to payers or farmer facility.
And when you look at philadelphia, you know, we have some of the best health care in the world here and we do remarkable things and that's around the country and other parts of the world as well. So when i had the privilege to get to know steve clasco the then ceo of jefferson health and the growth opportunity i was actually working up in montreal at mcgill university and i'd set up a center health care innovation that was very much like an incubator.
It was 30, 000 square feet and you could bring, you know, equipment there. And we'd kind of do simulations and look at outcomes, but it was really in a bubble. I remember this clearly, and I met Steve, Steve said, Raj, you know, this thing you're doing up in Montreal, how big is it? 30, 000 square feet. He goes, what about if it was 15 million square feet?
That's what we have at Jefferson. That is now your laboratory. Okay. So that's the first piece around. You actually have that clinical care delivery system. Okay. Which, yes, in the past went end to end from cradle to grave, and now there's lots of differentiation there, and that differentiation is challenging because then that actually leads to fragmentation, right?
So, if you've got your app for diabetes, your app for heart failure, your app for behavioral health, like, how do all those connect together? That's a challenge. And the connector is really where you get your healthcare. And so what we focused on at Jefferson, we called it Jefferson Strategic Ventures, was really how do we bring in.
These amazing technologies that are built like companies that are funded out of general catalyst or other venture on seven wire and so forth bring them in because that's the best technology and they have the financing is a vacuum and then what do we have we have the clinical credibility. And we have those 15 million square feet to be able to do this stuff.
And you put that together as a true partnership. I should actually say, I have two bosses at Jefferson. One is Steve Glasgow as the CEO. The other is the CEO of every company we've done a deal with. And if both of them are happy, then we're going to do well. And so one of our example programs was for the company called Livongo, a diabetes management company.
They came in and they said, Hey, we're, we're working with all these large self insured employers. We'd like to work with patients. And actually we tried to get that going with either our endocrinology department or our primary care docs. It wasn't easy. Let's put it that way. So what we did is, hey, hang on.
You're already selling to self insured employers. What? We have 35, 000 employees. We're self insured. Why don't we do that? But the benefit here is not only do you have all the claims data and we can offer this to our employees. Our employees generally use Jefferson for their health care delivery to now we get all the utilization data, the clinical data.
We put all that together. We gave this to our employees and. It was a game changer for Livongo as a company, because now they didn't just have claimed data, but they actually said, Oh, we're reducing primary care visits. We're reducing ed visits, all of that stuff. That data actually went into longer as S1.
They had 168, 000 members, um, across the country. Less than 1 percent of those were from Jefferson, but our data went into that because it was so valuable. So that was the value of the partnership around this digital health company and this care delivery system. And what we did there, Megan, as you know, is one, there's something that's not on the shelf that we want to be able to have and be able to deliver that for our enterprise.
Two, it drives an innovation mindset. I mean, Steve Clasco is just amazing at that. And now I know many other centers are doing that work to be blunt. It also creates alternative sources of revenue for us as a health system, over and above the operating revenues that we have. So that's what we did at Jefferson.
And I will say that was instrumental, but that really made me understand. And okay, to be successful as a digital health company. You've really got to pop on up with the health system and I'm sure we'll go into this, but that's our approach exactly where they're looking to build and scale 2030 health too.
[00:11:46] Megan Antonelli: Great. Yeah, no, I mean, it's um, yeah, you guys were sort of one of the first for sure. And now we're seeing that happen where Established VCs are partnering with hospitals to create incubators, labs, and even opening hospitals. So it is, we're purchasing them. There's a lot going on there. Of course, at the same time, funding is tight.
The resources are tight in healthcare. And I think there's also, you mentioned Livongo. We've been talking a lot on the show and at conferences about the Peterson Institute. Study, let's talk a little bit about value and metrics. You know, how are you measuring that? What does success look like for patients for health systems that are using deploying 2030 health?
[00:12:28] Dr. Raj: Let me just start with, you know, my experience as a clinician. If a patient comes to me, what do they want? They've got a problem. They're sick in some way and they want that taken away. And then you think about it from a financial perspective. Yeah. Someone that's sick generally costs more at a per month basis, especially if they've got a chronic disease that someone than someone as well.
And then that person that's sick, guess what? They're not as productive at work. We have 160 million Americans that get their health insurance through their employer. And so to put this in the context of 2030 health, and then I'll focus in a little bit more around our business model, I mentioned there's 110 million Americans in this country that deal with obesity that leads to.
All of the chronic diseases that really affect the majority of our society. I've already mentioned diabetes, hypertension, polycystic ovaries, reflux disease, liver disease, sleep apnea, and so forth. The last count in 2019 was that needs to have 480 billion of direct medical costs out of the 4. 2 trillion that we spend every year in this country.
But in addition, it leads to 1. 2 trillion of lost economic productivity. So that's 1. 7 trillion thereabouts if you put it together at a very simple level. Right. So we're on a mission to really not just impact obesity, to end obesity. And this is not about us spending billions of dollars to find drugs or to find devices or to find surgery or other interventions.
This is about execution. We already, I used to actually say, you know, like this name when I would go to, whether it's HMS or HLTH or other events, I'm like, wow, you look at the exhibit hall and you look at the 400 companies or the 4, 000 companies that are out there. We should just shut the doors, not let a single company in.
And now let's figure out how to solve behavioral health, women's health, obesity, something else with just these companies. Let's not fund any more. Let's get the VCs to just invest in these companies and figure out which are the best 10 or the 40 or the 100. And it's about execution, right? That's where we're at versus here's another one, here's another one, here's another one.
[00:14:48] Megan Antonelli: Well, isn't that true for everything? I mean, and that's, you know, what I like about, sorry to interrupt, but it's like the, you're taking both the holistic approach to the disease and the patient. But you're also looking at that from the sustainability business model too, you're saying, you know, we basically are serving the patient, the provider, you know, the, the industry, the market, the employer in that, and then on the, on the other side by doing so, giving, giving the patients the tools that they need in a holistic way.
So I like that and I think, you know, how you. Execute it. So you're talking about the execution and you said we can cure obesity. And I think that's an interesting concept, you know, and that, of course, we all sit here and that's why we're here, right? I mean, that's what, you know, pharma is here to cure disease.
We believe in that. I think there's a healthy dose of skepticism around, you know, sometimes you think, well, could they do that? And the idea that if we close the door, we probably all could, you know, but we get distracted. There's the shiny, the shiny new thing and what have you. But the tools are there. I'd love to hear your thoughts on what does execution look like?
And I think to some degree, it's like execution for the patient to tackle the disease and the partners that they have in that, of course, but also the industry.
[00:16:06] Dr. Raj: Absolutely. So the way we. focus on this is really around looking at the patient first, but then the providers are also consumers of digital health as well.
We have this platform. 2030 Health is not here to do care delivery. That's for the healthcare delivery systems to do. We are here to do care coordination, care navigation. Just as I mentioned, when you have a cancer center, care is connected. Yes, it can still be better, right? It's not perfect. And so what we do is we go into the health system and we say, well, what are your problems when you do take care of someone, whether it's in the bariatric surgery unit, whether it's for medications and so forth.
And the biggest problem is, I'll tell you this, when I was at Jefferson, if there was a patient who came and said, hey, I want Jefferson to take care of my obesity and my related diabetes and hypertension and sleep apnea. They could go to one of 12 sites across Jefferson, whether it was surgery, whether it was, um, internal medicine, whether it's endocrinology, whether it was nutrition, whether it's integrative medicine, and guess what?
They got each other different treatment and guess what? We all competed with each other because how do I get paid? I get paid by doing more surgeries, right? And the chronology gets paid by doing more, very low calorie diets or by putting people on medication that does not work in this economy. Right. So how do we do this?
The approach here is, we've already talked about this from a disease burden perspective, the more chronic diseases that someone has, which is related to a high degree of obesity, whether it's class one to class three obesity, that's what their total cost of care is higher. You have one chronic disease, it's double, you have three chronic diseases, it's triple.
And so what we want to do is say, if there's a treatment journey for this cohort that enables them to reduce the level of chronic disease burden, let's say remission of diabetes or just management of diabetes, so they're on less insulin or they're off insulin. Or management of their polycystic ovarian syndrome.
So they're not infertile anymore and they don't need to have IVF and can have a normal pregnancy that leads to a reduction in total cost of care. So we've actually done this as a claims based analytic, but worked with an actuary and we've looked at over 1 million lines of data and we've said, what are the cohorts?
Of the 16 chronic diseases that are associated with obesity. What's the total cost of care for each of those cohorts? And then what if these individuals had surgery, had surgery, plus some medication, had medication, plus some lifestyle in that same way. And then what happens to the total cost of care? It comes down.
Now it's got to come down by greater than the actual outlay. And so the approach here is actually, someone said this to me is. We are doing the right thing by the patient. We are so the patient experience is better. We are also supporting the providers to be more efficient and more engaged because the digital health solution or the care coordination actually helping them.
And then the third thing is we're improving the outcomes and the outcomes. I've always said a clinical, operational and financial. It's a clinical. There's a lower, um, the burden. The patients are healthier. Number of my patients who just said, wow, I wish I'd done this sooner. Be in control of them. The operational metrics is patients are getting through this journey sooner.
Their complication rates, their recurrence rates are lower and then financial, the total cost of care goes down. Now, if you do this across a population, I mentioned the cost in terms of direct medical costs of almost 480 billion dollars in lost economic productivity. There's actually a pretty strong economic base based on that risk stratification, their care journeys and the outcomes of interest.
[00:19:57] Megan Antonelli: Wow, that's amazing. I mean, I think in terms of what, what the mix is, I mean, obviously there's been so much attention to JLP ones and how effective they are. And they are, you know, I mean, there's, there's no doubt that weight loss is a result of taking these. Now they come with side effects, other risks.
There's a lot of discussion of what do you do next? Do you have to be on them forever? As you're entering this space at this time where these have become the topic of the day around obesity management, what are you seeing in terms of both provider acceptance, adoption, but then also the future, uh, what do you envision as the future of the right mix and what's important?
[00:20:42] Dr. Raj: So the first thing I just want to say, and it will be a little bit of a science lesson. We've heard about a Zenpeg and Wigovy and Manjaro probably for the last two years. You know, it was mentioned by Jimmy Kimmel at the Oscars last year, but GLP ones have been around for almost 20 years. The first GLP 1 was a xenotype that was actually approved by the FDA back in 2005.
And it's interesting, the first reported discovery of a related hormone called GIP and GLP 1 were in the 1970s and 1980s. Actually back at Imperial College London was where GLP 1 was actually discovered back in 1987 by Steve Bloom, who's head of internal medicine there. This is not like, oh my god, it's suddenly like, where did this come from?
People with diabetes have been on drugs such as Xenotide, such as Liraglutide, you might call them Dictosa, Trulicity, those kinds of drugs. What has changed? In the last two to three years in terms of the data that's come out has been the degree of weight loss that we're seeing it was more like five to 8 percent and now it's more like 15 percent 20 percent and even some of the newer drugs, right?
Is up to 25%. And so the first thing I want to say is this is just an amazing biotechnology advanced, like we are living in an amazing age of science. And I remember saying, you'll laugh at this, Megan, 20 years ago, when I started doing bariatric surgery, I'd say to patients of mine, I said. Someday, like you need a gastric bypass today.
Someday there will be a drug. That will do this, could we know this was back at Imperial college, where, you know, job you want to first discovered and that company is likely to be worth more than Google and Facebook and Amazon put together is worth more than the whole of Denmark,
[00:22:34] Megan Antonelli: right? It's crazy.
[00:22:37] Dr. Raj: So that's a little bit of the background.
I actually answer your question. Yes, these glp one drugs and then additional G. I. P. And other drugs is about almost a hundred drugs in development right now in this space. And obviously we know about Novo. We know that Eli, but and Jen and other companies are out there doing this stuff as well. When you say that the mean weight loss for semiglutide is 14.
8 percent the word mean gets forgotten when the media mentions it means there's a range. And so just go back to the, to the study published on semi glutide in the New England Journal, back in 2021, there were 16 percent of individuals in that clinical trial, a control clinical trial, who did not lose more than 5 percent of their total body weight.
So it's one in six people at one year. So for those individuals, this drug was not efficacious, simply put, didn't work. There was another study just published a couple of weeks ago that said at two years. It's actually 33 percent of people that don't lose more than 5 percent of their total body. So for these individuals that if you're paying a thousand to 1, 300 a month and not getting that degree of weight loss, which then relates to, you know, 5 percent weight losses can help you prevent from your diabetes can help your osteoarthritis a little bit, but it's not going to help you live a disease.
It's not going to help your heart failure. And so the challenge here is how do you identify those individuals before you So between one in six, one in three individuals, all the data shows that 40 percent of individuals at one year are not taking the drug anymore. We don't know why that is. It could be because of side effects.
55 percent of people have mild to moderate side effects, right? And supply chain issues, or it could be they don't want to take the drug anymore, right? For whatever reason. Now, GMO. Maybe they
[00:24:44] Megan Antonelli: like food.
[00:24:45] Dr. Raj: Yeah, no, Jen's false. She met a few weeks ago. It was actually one of the first researchers to develop G.
R. P. One drugs back in the early two thousands back in Copenhagen. I don't think people are going to be on G. R. P. One drugs for the rest of their life because Yeah, they want to live life. It's miserable. Like food. I used to say to my patients, we eat with our friends. We eat with our coworkers. We eat with our family, right?
I've actually had a handful of patients who've come to me and said, you know, they've lost a hundred pounds in weight. They're off all their meds, that kind of stuff. I'm saying, how are you doing? I'm pretty miserable. This man was a construction worker and he's like, I can't eat with my friends anymore because they're all eating the fried chicken or something else.
We don't go bowling anymore because. I'm just not, uh, drinking any alcohol anymore because I can't and I don't want to. It is a social phenomenon. Now, this is not saying that, Oh, these drugs are bad. Again, it goes back to what we've already said is it needs to be that multimodal. Right.
[00:25:52] Megan Antonelli: So my question in that, you know, which, cause I think, you know, both, You know, you hear about that and, and I think it's true, you know, they are, while that they work, and, and as you said, you know, not for everybody, but they can be extremely effective, but it is a life choice, just like being on a diet forever, you know, a restrictive diet is, is a difficult thing to do.
So what is the behavioral health component? Cause I think so much of continue, you know, continuing to maintain and finding that right balance, right? Whether that's, you know, intermittent fasting four days, four days out of three, you know, people find that balance so that they can still enjoy life and be healthy.
What is the, but it is, that's a behavioral choice. You know, what are the components that you you're working on with, with 2030 health and, and you know, that you see working?
[00:26:45] Dr. Raj: I'm going to just analogize this, if someone's dealing with obesity, a number of chronic diseases, they need a rocket boost to get going.
And that rocket boost might be six months, a year of a GLP one drug, it might be bariatric surgery, but then it's about maintenance. And that's really where I think lifestyle is important to set you up for success initially, but it's really around the nutrition, the behavioral, the exercise factors. And the other piece around this, which I saw with many of my patients is peer to peer.
How does one individual support each other? You know, I always say this. If I'm going to go to the gym and someone else is there waiting for me, I'm much more likely to go right on my own. And the analogy here that I had is from a behavioral health perspective. If someone has an acute psychotic episode, we've got schizophrenia, they need medication now to get them back down to some degree of baseline.
But that medication is just going to get them down to that degree of baseline. Now that medication needs to be coupled with counseling. And support to help them get through chronic periods. And then the same way we can have a kickstart and how we do that by creating this research and Nick Krastakis has written a paper in the New England Journal of almost 20 years ago now around who you, it was separate to the Wall Street Journal as well, but it basically said, you know, there are clusters around the population.
Oh, yeah, yeah,
[00:28:13] Megan Antonelli: yeah. Right. It
[00:28:14] Dr. Raj: was like who you hang out with decides whether you become a beast or not. Let's put it the other way around who you hang out with in terms of these clusters. If there are people that are losing weight and getting healthier, then you're likely to lose weight and become healthier as well.
So that kind of social phenomenon. So that's how we're certainly thinking about it, about creating these, haven't built it yet, but we're looking into it around kind of network so that people can support each other. each other and then the coaches as well that can support those individuals.
[00:28:42] Megan Antonelli: Right. And I think that's so important both from the peer to peer support models but also because these drugs are new and this methodology, if you will, is new.
Or the adoption of them for weight loss is new, maybe not from a diabetes treatment perspective, but people who have managed diabetes actively are used to managing their care on a long term basis for obesity. We have to teach that and have that both from peer to peer and from your physicians. Now, what about, I think access comes up a lot, access around.
You know, and that this applies not just to GLP ones. It applies to bariatric surgery, too. Even though there's coverage for it, people don't always get it. Availability doesn't equal access. So talk a little bit about equity. I mean, because obesity certainly hits a socioeconomic group more than others.
When we talk about curing it. Can we cure it for everyone or only for those who need to look good in the dress on Tuesday?
[00:29:45] Dr. Raj: The simple answer to your last question is yes, not only can we, we must, because why did I get into healthcare as a provider? Because healthcare is a right for every single person.
Man, child, woman in the world, right? And so, you know, health care should not discriminate. Sadly, it does, though, and obesity, women, black Americans, Hispanics and low socioeconomic individuals are more likely more predisposed to be dealing with obesity in the related chronic diseases. Sadly, they're less likely to seek care for their obesity.
And we've seen this in other areas as well, specifically with breast cancer. And thirdly, the trifecta is their outcomes are inferior. And so there's data from this. One of our advisors, David Sauer, he's, um, the associate dean of the college of public health at Temple university. He's done a lot of research.
Dave and I used to work together when I was a parent and he's shown that if you have a hundred individuals. They're going through a journey to get bariatric surgery. The white male is more likely to get the surgery than the black female. Same, same setting in Philadelphia, right? There is discrimination that we know this in other areas, as I mentioned, cancer and trauma care.
And then the outcomes is lady in Florida, Cynthia Buffington. I remember reading her papers, you know, almost 20 years ago, that was black females, their outcomes. They didn't lose as much weight. They didn't get off their diabetes meds. This is crazy. You do the same gastric bypass, right? And so there is a lot of complexity here.
And the way I kind of take this. If I may, as I mentioned, Jimmy Kimmel at the Oscars. I remember watching that and thinking when he asked is his MP right for me and, or all these Hollywood stars on it, he made a joke of it 30 years ago, my favorite movies, Philadelphia won the Oscar for best film. And Bruce Springsteen won the Oscar for best song.
We all remember Philadelphia and the discrimination that Tom Hanks and his character had and had to hire an attorney to help him. I remember thinking, wow, at that time. HIV and AIDS was a disease for men who wanted to have sex with men, and it was their choice. And where are we now, 30 years later? One, we have the biotechnology advances to pretty much cure HIV.
I mean, it's undetectable as a virus, and these are shots that you can take once every two months. And now people can live a full, normal life with HIV. And the discrimination, it hasn't fully gone away, but it's certainly much more subdued. And so I think about, I hope it doesn't take 30 years for us to get to the point where we have, we've already said this, we have the treatment.
It's about really focusing on taking care of our communities and saying, this is the right to do, whether it's. Bariatric surgery, medications, nutrition, behavioral exercise, all of the above from a risk stratification perspective and then engaging these individuals. And I'll say, we talk about 5 year cancer free survival.
We talk about at the NFL, the crucial catch for cancer, or why don't we talk about 5 year obesity free survival. Why don't we talk about, Hey, let's take care of an individual with obesity. It was a very interesting study published out of the UK last week, which said there were 500 men. They were on a, on an app to try to lose weight.
And if you gave them financial incentives, they lost more weight. So that was published. We said, Oh, okay. That makes sense. And head Carl, he's a pretty interesting guy. I mean, obesity space, he writes a lot on this. He said, that's interesting. Imagine if we gave people money for that cancer getting smaller.
You can understand how this comes about, but now it's like, well, it's your fault. And if you get money for it, then you'll change your behavior. Well, Hey, hang on. We would never think about doing that and really maybe jump out of my seat. It's like, wow.
[00:34:05] Megan Antonelli: For
[00:34:05] Dr. Raj: sure.
[00:34:06] Megan Antonelli: Yeah, it is. And, and that sort of the inherent.
Discrimination that's there coupled with the inherent biases in the system make it that much more challenging to then get to that point where people truly have access and the support they need to then execute. As you said, it's all about execution. When it comes to that, I wanted to hear, because I know you come, you know, in that partnering with the hospital model and making sure that there's value for all players.
You know, you're a physician. Who also does believe in value based care, whether or not that's what we call it, or it's care that is valuable and helps the patient tell me a little bit about, you know, bariatric surgery was not always covered and it got to the point where it is, but some people still don't get access to it with GLP ones that coverage or no coverage, you know, where does value based care fit into this, right?
Because we're seeing the value of all of those downstream impacts are true from a financial standpoint. Perhaps not at the price that they are, but when prices come down slightly, there will be value there. What is your kind of prediction thoughts of how this all works together in a value based care model?
[00:35:22] Dr. Raj: The first thing I'll tell you is a little bit of a funny story that Bob Wachter told me at UCSF. And when the Affordable Care Act came out, he said that he was about to do rounds with a bunch of medical students. And he said to them, wow, this is a turning point in American health care, right? We're going to be focusing on value based health care, right?
Which means that we're going to be doing things that achieve outcomes that reduce the total cost for a population. They said, one of the medical students said, Dr. Walter, what have you been doing for the last 30 years then? Right. His mother had an apple pie, right? But there is just so much complexity in our health care delivery systems for how to achieve that.
So, Where I go with this from, let's just take it this specific obesity lens, is we want to identify individuals when we look at that risk stratification that I said, we've looked at a million lives and we've looked at class 1, 2, 3 obesity. And here are the degrees of chronic disease. Here is the total cost of care.
It's a simple math equation. This is the total cost of care for this cohort or this individual. And we want to get it down to here by spending this much can be medications or surgery or lifestyle therapies. And that's where we need to start. And it may not be by the most expensive people from a total cost of capitalization, usually the middle.
And then how do we reduce that, but also reduce the variation, right? There's a variation is to actually what costs money versus the meat. And so our focus is 2030 health is identify those cohorts partner off with the health systems. Not only for their patients, but also for their own employees, and then enable them to develop contracts with other self insured entities, whether they're employers, health plans, unions, to really show that we can reduce the total cost of care.
As the price of the drugs come down, the price of the surgery can also come down as we move the surgeries from inpatient to outpatient ambulatory surgery centers. That's something that we're looking at today as well. Just like what's happened in hip and knee, and in GI, and in cardiology. There is an, an economic incentive, and I'll tell you, there's not one bariatric surgeon out there that says, I don't want to do more surgery.
Right. Uh, or I'm maxed out. And then in terms of the drugs, there are. As I said, so many drugs in pipeline right now, the cost is going to come down. It's not going to come down like overnight, but it is. And we've done some analysis actually internally, and we think the right price for a GLP or a GIP or one of these other drugs is about 300 a month.
That is then the break even where we can then really treat the entire population.
[00:37:58] Megan Antonelli: Yeah. So that, I mean, I think that's the view of that is where we, you know, it all equals out and, and then that access comes. So that is, you know, a hopeful and optimistic view of it. I think the thing that Dr. Wachter said is funny.
And I've had that conversation a few times lately as we've been talking through how value based care comes to practice in that we stopped calling it that.
[00:38:23] Dr. Raj: And we talked about it briefly previously is also. The digital infrastructure to achieve that, as you have, you know, we still call it again, I'm mentioning Steve too many times, but, you know, Steve always used to say, we don't call it telebanking.
We just call it banking. It's not digital health. It's just healthcare on a digital platform. It's just done healthcare, right? So how do we get all our individuals engaged? And obviously we have the massive surge with COVID and I know you had Ed Marks talking about this recently about how those numbers have gone down and people want to come, um, uh, kind of on site and discuss it.
No, we need to make sure not only because it reduces costs, but actually the outcomes are better because we could be tracking everything. We, you know, Well, through that remote monitoring, through that telehealth, we can actually be seeing people and saying, yeah, maybe we could do this a little bit better versus taking half a day out and driving into center city, Philadelphia to see me for 20 minutes,
[00:39:18] Megan Antonelli: right?
Well, and that goes back to a lot of the conversation we've had around AI implementation, where AI fits in, you know, AI, for lack of a better word at this point does mean digital health, right? It's almost synonymous, synonymous, but, you know, It's not about AI doing the surgeries, it's about AI doing all the other things that maybe didn't get done or we didn't want to do, right?
So I think it's really interesting that you're saying the cost of surgery is going to go down and that will allow them to do more. I mean, that's got to be having to do with digital enablement, right?
[00:39:52] Dr. Raj: Yes, absolutely. And then related to that, once we have, you know, we're getting there, all of this on a digital platform, then we can have real time measurement of outcomes, right?
And now what I want. Is that no patient goes through a care journey. On the 2030 health platform without care that is in the top 10 percent of the care that's delivered today. And now let's raise all boats to say, let's get everyone that top 10 percent of care. So, that also relates to the health inequities piece that everyone should be able to get the care.
That you and I are privileged to get
[00:40:27] Megan Antonelli: and I have one more question or running out of time and I, uh, but I, I could talk to you all day, but one of the things we've been talking a lot, we've talked to Dr Bonnie Feldman, who started remission and so, you know, for, uh, autoimmune diseases, you know, a care platform, we talked to Ashley wisdom, health in her hue, health access and education and a platform for women of color.
There's so many kind of niche digital providers, right? Some specialty based, some disease based, some, you know, whether it's gender or race based. And I wonder, as I see this, you know, we talked in the beginning of all this with technology, we talked about continuity, the collaborative, you know, and are we at risk for.
Creating more disjointedness with some of these health coaches and platforms. And I think of obesity, which is something that has so many comorbidities. So tell me about the context of that. Tell me just how you're thinking about that and where 2030 health fits in.
[00:41:30] Dr. Raj: Yeah, I love the question, Megan. It's very insightful.
And I'll tell you now 2030 health fits in right now, you know, we're still in our early stages. We've got our first few health systems that we're working with around the country. We have patients live on our platform right now. We don't have kind of, it's a pretty general platform versus someone who has a socioeconomic status that's different or someone has a race that's different or a gender that's different.
And so the way to think about this, we will never be everything to every, everyone, right? Whether in one state or across America or around the world. I mean, we already have interest from going to the yellow bus while that leads to India and China as you can imagine. And so, the way I think about this is that we really want to be the honest broker for anyone that is going through a obesity care gym.
And so, if there is a partner that we can work with that focuses more on a particular racial group, or a gender group, or a societal group, we're happy to work with that. And so we can become that common middle where ends when this is the care journey, we'll partner with you. How we do that. I think the simplest example I'll give you is I met with Toyin Ajayi from city block health, and you know, she's phenomenal and the company's phenomenal.
I think it's one of the best, if not the best companies out there. That's just doing amazing hard work. And I said, you know, we're not ready right now, but I'd love to figure out some way where we can work together because I don't want to build out. The same system that you have right to take care of the population that you take care of.
I want us to work together in partnership to be able to do that. So that's how I think about this. It's a kind of more of a medium to longer term approach. Um, but right now it is a limitation that we're pretty much building that platform and then we can look to partner with other entities.
[00:43:28] Megan Antonelli: Yeah, it may be that we came to this with a little bit of, you know, when we said it needs to be a continuum, I'm starting to think maybe that's an assumption we made that's not necessarily true.
And not to say we want a more disjointed healthcare, but to sacrifice hyper personalization, which is what it is, really. I identify as obese. I identify as a Black woman. I want my care to come through that lens. And therefore it's hyper personalized and that might, the sacrifice of true connectedness, it might be easy to
[00:44:01] Dr. Raj: overcome.
So, um, One, one add on that is. We're not just a technology platform. We have human health coaches. Hillary is our first health coach. We're hiring a few more right now. And our approach is to do some degree of magic around those human health coaches. All our health coaches are not going to be white males or white females.
And so maybe there is that. Megan would like to be a partner with someone who's like this versus Roger would like to be partnered with someone who's like this and then you create that relationship. So I think that's something that we can do or we are doing right now. Great. Stand and scale.
[00:44:39] Megan Antonelli: Awesome. Well, tell us, you know, as we like to talk about good things and the good things happening, tell us one, of course, share with our audience how they can reach you.
I think one of my favorite newsletters is yours. So. Be sure to mention how people can subscribe to that. So share that information and how folks can reach you and get in touch.
[00:44:58] Dr. Raj: Wonderful. Well, Megan, first of all, thank you so much. It's so thrilling to spend time with you. It's just energizing to see you and to talk about all this stuff.
So yes, I write a weekly newsletter. I write it myself. I started doing this almost two years ago, which takes all of the news around obesity and metabolic care, whether it's from the publications in the journals, whether it's from what happened at the Oscars, that kind of stuff. It's called Perspectives Across Obesity and Metabolic Care.
You can find it on Substack as a newsletter. So that's one thing. And then in terms of 2030 is T W E N T Y three zero dot health. That's our website, but you can find me at Raj at 2030 dot health as well. I I'm feeling just so privileged and thrilled to be in the space to have taken over two decades of my experience and to really.
And why did I start this company to have impact across millions of lives and we're on our way.
[00:45:55] Megan Antonelli: Well, we are all about health impact here. So thank you so much, Raj. It's really, it's a pleasure. Um, I, I really, you know, one of my favorite topics and one of my favorite people. So thanks so much for joining us and thank you to our audience for tuning in to this episode of digital health talks until next time, be well and keep innovating.
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