With progress faltering in reducing diseases and chronic conditions such as diabetes, obesity, high blood pressure and heart disease through prescription drugs, the healthcare sector is increasingly turning to technologies that incorporate data algorithms and lifestyle coaches to improve patient behavior.
The newest local entrant in this booming field is Nudj Health Inc. Based in Pasadena, which in April raised $10 million in seed funding to advance its efforts to partner with physician groups to track and change patient lifestyle behaviors.
“About 80% of all chronic conditions and diseases can be prevented, reduced or reversed through lifestyle changes,” said Yuri Sudhakar, founder and CEO of Nudj Health. “But until now, doctors have been routinely giving patients instructions about taking medications and getting more exercise, but they have very little sense of what’s really going on with patients once those patients leave their offices.”
As a result, improvements in patient lifestyle decisions often do not persist in the long term.
“This is where we come in,” Sudakar said. “We bring in a ‘advisory care team’ that continues care after a patient leaves the doctor’s office. We work on daily exercise routines, choose meals, and take medications correctly with patients.”
With this continuous patient enhancement, he said, “Satisfaction is higher. Patients know they have a plan and the people on their care team help them carry out that plan.”
Nudj Health uses the latest reporting and tracking technology to make this happen. Much of the interaction with patients happens over the phone, while in the background Nudj Health uses algorithms developed by accumulating data from patients to guide decision points.
“The pandemic has really helped here, by making patients and providers realize the value of telehealth,” Sudakar said.
The pandemic has also helped expand Ng’s service offerings, he said. Due to the increased isolation resulting from measures aimed at decreasing transmission of Covid-19, more patients are depressed and therefore less likely to be motivated to adopt healthy lifestyle habits.
“Maintaining good mental health is becoming an increasingly important part of what we do,” Sudhakar said.
Data collection roots
Sudhakar previously co-founded and later sold a company that collected data from implantable defibrillators and other heart devices. That company, Geneva Healthcare, was sold to Biotel Inc. In Malvern, Pa. (ed.). In 2019. Biotel in turn acquired the Phillips Healthcare Group, a unit of Koninklijke Philips headquartered in Amsterdam, Netherlands.
Sudhakar remained at Biotel for some time, but left in late 2020 with a focus on his next project: using data aggregation acumen to improve behavioral health outcomes. He collaborated in late 2020 with an investment partner, Donald Cohn, and the couple launched Nudj in February 2021. Cohn, who comes from the real estate industry, is now a member of Nudj’s board of directors.
Nudj is one of a growing number of companies launched in the United States and elsewhere over the past few years with the same goal: improving patient outcomes through changing lifestyle choices and behaviors.
Catherine Collings, MD, president of the American College of St.Louis, based in the Department of Health and Lifestyle Medicine, said: Health Ng recently joined the college as a board member. “But now, the evidence has come in and we’ve found that it’s not very effective.”
So attention has shifted to the lifestyle and behavioral choices that make up these diseases and conditions, Collings said. This has been helped by an increase in the number of people trained as “lifestyle coaches” who can guide patients to healthy outcomes through improved nutrition and regular exercise.
Collings added that the focus on the behavioral health components of chronic disease management differs from traditional corporate wellness programs. These programs offer things like free gym memberships and health checks but do not assign individual lifestyle coaches to patients and do not require patients to report key health vital statistics on a regular basis.
“You have insurance companies trying to find out,” she said. “And you have a growing number of small businesses trying to go in and solve this in a more flexible way, through the use of artificial intelligence that makes training more personalized and more effective.”
One such company is Ontrack, which earlier this year moved to Henderson, Nevada from Santa Monica. Ontrack is using artificial intelligence software and lifestyle coaches to help healthcare payers – mainly insurance companies – save money by reducing hospital admissions.
But Ontrack ran into difficulties when two of its biggest insurer clients — Aetna, a subsidiary of Woonsocket, Rhode Island-based CVS Health Corp, and Connecticut-based health giant Cigna Corp Bloomfield — dropped its program. Aetna ended their engagement, while Cigna turned to another behavioral healthcare startup, Ginger.io, Inc. It is based in San Francisco.
Ontrack has been trying to expand its customer base to include employers and physician groups, but these efforts have been slow to take hold.
However, Nog immediately focused on the healthcare provider market, especially physician groups.
“We come from the provider space and understand how to work with providers in the clinical workflow,” Sudhakar said. “This is where confidence stems from.”
Throughout her first year, NJ has primarily focused on the aged care market. That’s because the Federal Centers for Medicare and Medicaid Services, which administers Medicare, has approved a model for including mental health/behavioral health services within provider networks.
“This means that providers get reimbursed from Medicare for mental health/behavioral health programs designed to improve patient outcomes, so they don’t have to spend extra money to partner with us,” Sudakar said.
Providers are motivated to work with Nudj because of evidence from a University of Washington study showing that every dollar spent on these programs results in nearly $6 savings from reduced use of more expensive medical treatment, especially in a hospital setting.
Sudhakar said that during the first 15 months of Nudj, she signed “somewhere around ten contracts” with service provider groups. He declined to disclose revenue.
One such provider group is the Foothill Cardiology Medical Group in Pasadena. The group’s president, Dr. Azil (Alex) Douriraj, who is also the medical director of the Cardiovascular Services line at Huntington Hospital in Pasadena, said he’s been with the Nudj Health team since its founding early last year.
“In the year or so since we actually started using their program, we’ve seen about 40% reduction in scores for anxiety, depression, and insomnia among our patients,” Durraj said. “We also see less rise in blood pressure and more compliance with medication.”
As a result, he said, “we’re seeing fewer hospital and urgent care visits.”
But Durairaj noted one tricky area: some patients are concerned about collecting blood pressure and other data points and how those data might be used in the future.
“Some patients have declined to participate because they are concerned that blood pressure readings may somehow end up in the hands of insurance companies and that their contributions will suddenly increase,” he said.
But that, he said, is matched more by a larger group of patients who are motivated to improve their behavior because they know someone is watching them.
Transition to value-based care
Announced in April, Nudj’s Series A $10 million funding round led by Nebraska Medicine of Omaha, Neb. San Diego-based Teal Venture; Cohn Family Fund (for the aforementioned real estate investor Donald Cohn); and the Gulf Health Innovation Program.
Sudakar said some of that funding will likely be used to expand into value-based medicine, where groups of doctors are given a set amount of money from healthcare payers to manage a certain number of patients and have to try to find ways to save treatment dollars to make money.