Deja de contar ovejas: explora la transformación digital que está abordando la apnea del sueño

Dr. Daniel Rifkin: Well, it came to me in a dream. No, just kidding, it actually, it...

Clinton Bonner: (Laughs)

(CATALYST THEME MUSIC)

Clinton: Welcome to Catalyst, the Launch by NTT Data podcast. Catalyst is an ongoing discussion for digital leaders dissatisfied with the status quo, and yet optimistic about what's possible through smart technology and great people. Be sure to subscribe in your audio feed and help spread the word on these very worthy discussions. Today, we've got a very special guest whose team is tackling an incredibly important topic for all humans. You've probably heard the term "better living through chemistry." Well, how about the term, better sleep through technology? Dr. Daniel Rifkin is the chief executive officer and founder of Ognomy Sleep, the sleep apnea app, and he joins us in the Catalyst Studio today. Dr. Dan, welcome, my friend. How is everything up in Buffalo? How are you and the team doing?

Daniel: Ha ha, hi, Clinton, it's great to see you again. We're doing fantastic. We're continuing to grow as a company. We're hiring more people. We're raising more capital, which we need to continue to grow. But things are going really well, thank you. I hope you're doing well too.

Clinton: Doing fantastic, thank you for asking. Obviously, folks who are listening, Dr. Dan and I have a history, we've worked together in some years past, back in... Kind of just before Covid, you know, came into the world, and did some really cool work together. So I knew about the platform and the app that his team was constructing when it was kind of just getting going, which was a lot of fun. And I want folks to understand the problem, right? That's the big thing. So, as we get going, I said it in the preamble, that Ognomy sleep is really, you're coining it the sleep apnea app. So what do folks need to know about the disruption of sleep apnea? The seriousness of it, the affliction? How many people does it affect? And then, if you could, you know, kind of careen into, what is Ognomy sleep doing, and what's your mission when it comes to this affliction?

Daniel: Sure. You know, sleep apnea, it's a disorder that's highly underdiagnosed and undertreated, and it's just one of those things that just falls under the radar. It's not typically top of mind when you go to see a doctor, despite the fact that it sort of interdigitates into so many different diseases. And, like, for example, sleep apnea, if left untreated, can lead to high blood pressure, can increase your risk of heart disease, stroke. I could go on and on with all these downstream diseases. And it's something that we should recognize, because it affects a billion people in the world.

Clinton: Wow. Okay.

Daniel: Yeah.

Clinton: And there's only about 8.2 billion or so, right?

Daniel: Yeah, exactly.

Clinton: So we're talking, we're talking 1 in 8 people are suffering from some grade, if you will, of sleep apnea. That's a billion people. That's a big deal.

Daniel: Right. And it's one of those diseases, too, that's... You need to think of it in a way, in terms of population health, because you need to address this in a population, not just on an individual basis. Which kind of led me to develop Ognomy as a way to truly tackle this disease in a population health type way.

Clinton: Curious name. So, where does that name come from? Is it, is it derived from, you know, an older language? Is it something the team came up with, you liked the way it sounded? What's that tale?

Daniel: It actually comes from the word physiognomy, which is the Greek term for diagnosis based on facial structure or facial features. So, there are certain facial features that you could see when you're even talking to someone that would lead you to believe that perhaps they might have obstructive sleep apnea. Because sleep apnea, I know we didn't talk about this yet, and I'm not sure how much your viewers know about the disease, but it's a sleep-related breathing disorder where the throat repeatedly collapses throughout the night. And that leads to disruption of sleep, leads to low oxygen levels during the night. And some people have a really small chin that's set back a little bit, and that's one of the facial features that we'll see in sleep apnea. So that's where the name comes from.

Clinton: So you said a billion people globally. I mean, you're up in Buffalo. Obviously you're creating a digital... a digital app that of course is global by nature, because, hey, we're all in the cloud and away we go. Anybody can go get it. But you are in Buffalo, so I'm assuming you're focusing to get the uptake in America, likely Canada as well. Is there a certain percentage or an estimated number, that the world of medicine understands, from, like, an American population percentage, that do suffer also from sleep apnea?

Daniel: Yeah, probably about 50 million adults are afflicted by sleep apnea. And probably more than 40 million remain undiagnosed and untreated. So we have a lot of work to do. Yeah.

Clinton: And that was the follow up is like, how many are not getting... not getting treatment? And then you gave the answer, so four out of five, or 80% of that 50 million, around, you know, roundabout numbers. But that's still huge. That's eight out of ten people who have it and are not getting treatment at all. So, typically, when you see, you know, it is serious, it causes major disruption, can cause major health problems. And yet, eight out of ten who do have it are not seeking help. So, that screams a couple things. That screams, ultimately, opportunity. And it also screams, well, what's wrong? What was wrong? What was the friction? Why was it hard that so many people are like, oh, I guess I'll just deal with it.

Daniel: I think one of the biggest reasons is that, you know, you need to live near an urban center or a highly populated area where you'll have a sleep center. So, sleep centers have sleep physicians that are centered around that. So if you live in a rural area, or if you live far away, the way we've been treating sleep apnea and recognizing it and diagnosing it is always through these sleep centers. So that's one of the big reasons why a lot of people remain undiagnosed and untreated. But there's also just the friction. And there are a lot of misconceptions about who should have sleep apnea, who shouldn't. So for the longest time, if you weren't overweight and an older man, it wouldn't even, like, your doctor wouldn't even think about it as a disease. You can be very thin, you can... be a young woman, and you have significant, severe sleep apnea. So, we have to change the way we're thinking about who has it, when should you be recognized for it and get diagnosed for it? So it's starting to become more mainstream in the medical field, where more doctors are recognizing it. You know, it's actually funny. When I first started in sleep... Gosh, it's a long time ago, 20-plus years ago, I came to Buffalo after a really good medical school training. I'm a board-certified neurologist and decided to subspecialize in sleep. And when I came to Buffalo, I decided to, you know, I'm going to do sleep medicine full time, and I'm going to address sleep apnea, which we started to know at the time, that can affect high blood pressure, and just started to get into how it affects heart disease. And I'm going to just start doing this. And I remember talking to one of my mentors, and he's like, Dan, what are you crazy? You know, why would you... you know, you have all this training, you're a neurologist, why wouldn't you... Why would you go into sleep? It's like a fad, right? Like, he talked about sleep apnea as a fad. And, sticking to my guns, I tried to explain to him that this is just the beginning of recognizing the disease. And if we can treat this disease, we can prevent downstream diseases like we talked about. So. I think it's one of those things where there are so many reasons why people don't get diagnosed and treated, and it starts with the patients not being near a sleep center. It ends with physicians not recognizing it. And there's also parts of, like, even if you get diagnosed, and, you know, you recognize that you have the disease, some of the treatments, a lot of people think, oh, the only treatment is a CPAP machine, and they see those pictures of people wearing this big mask on their face.

Clinton: Right.

Daniel: When, in fact, there are a lot of different ways we can address the illness today. Like, the CPAP works great, and if you can wear it and feel comfortable on it and stay compliant on it, it's an excellent treatment. But there are newer treatments, other ways to address it today. So, more and more patients are seeking treatment as well.

Clinton: Yeah. And so, I want to also just dive in a bit more to the current friction. So, yes, you need to be near a sleep center. And then, they also have to go in. And I would imagine... My understanding is, like, do the whole sleepover thing.

Daniel: Yeah.

Clinton: You know, like, stay a night or two over and get diagnosed, which is a big, big disruption. So if you decide to go get treatment, you know, eight out of ten not, or just don't have access, right? At the end of it, you get this, this machine that you might not want. And it seems big and scary. And, the middle is, you gotta get into a sleep center. And then, how much time does the typical person have to go spend? And what's that disruption like from, like, an average standpoint?

Daniel: Yeah. I mean, you're exactly right. And there are a lot of people that can't spend a night in a sleep center. You might be a single mom, or you don't have proper transportation at night, or something, but... You know, you typically get there at around 8:30 at night, you leave about 5:00 in the morning, and you have 34 electrodes attached to you all night long as someone's monitoring your sleep. Now, sleep apnea, because of all the sleep disruption, creates a lot of daytime sleepiness. And your ability to fall asleep is there. You don't have trouble falling asleep, even with all those electrodes on.

Clinton: Interesting.

Daniel: You know? And that's where, people also think, if you have insomnia, how am I going to sleep in a sleep laboratory? When in fact, we don't typically send insomnia patients to a sleep lab, because if you can't sleep at home, you're certainly not going to sleep in a center with all that stuff attached to you.

Clinton: Right.

Daniel: But it is arduous. It's an arduous process to get that done. And, and just talk about timing, too. You might live near a sleep center, but it might take you a month or two or even longer to get in to see the sleep physician, and then another couple months to get the actual sleep study, to get the diagnosis, and then maybe another few months to get the sleep study, to do the titration on the CPAP machine, to get the proper treatment. So it could take six months or longer, you know, to even get to the end game. Which is just... Why pursue that? (Laughs) And you know. you get... you forget halfway through the process, you know, what you need to do next. There's so much fragmentation and friction and pain that these patients experience, and it's repeated over and over and over. And I've recognized that for a long time.

Clinton: And again, that culmination of the things you just described equates to opportunity, right? That is the opportunity to disrupt, and use new techniques, use digital technologies, and just use, use mobile applications and things like that, to, (a), hopefully remove some of those frictions, maybe lessen the burden on people too. I also think a bit of it too, like... You know, Uber didn't succeed just because it removed friction. Like, yes, it did. But it really got gravity and its own pull because it was also better.

Daniel: Mhm.

Clinton: That was the other piece of it, too. If it was, like, just as good, and you ended up in a kind of a smelly yellow cab, but you pressed the button to get in the smelly yellow cab. Maybe not as a good of experience. But they uplevelled the experience and what the outcome was as well. But I also want to get back to a little bit of the... I understand that you decided to go into sleep, and your, some colleagues were saying, hey, hey, doc, that might be a fad. You might be, you know, chasing a goose there that you don't want to chase. Yet you did it. So, that's part one, you decide to go into sleep. But what about the next leap? Where, hey, you're a practicing MD doctor from Geisel School of Medicine at Dartmouth, and like you said, a certified neurologist. You didn't have to, doc, right? So... But yet you did. So what was that, that transition like, when you said, look, I am going to apply technology to this problem. And how did that process start for you? You know, kind of, was it you taking some tablets into a cave and coming out with an idea? Or was it you and a couple of colleagues saying, hey, I think we could do something digitally here?

Daniel: You know, it all started with the fact that my kids didn't want to play with me after dinner, and I needed to find something to do.

Clinton: (Laughs)

Daniel: They kind of grew up and they got older and older, so... But I actually went back to school for a degree in public health and graduated in 2018. And it was during that time that I started to learn more about obstructive sleep apnea, again, in this population health, global health standpoint. And I became concerned. Because the way we're addressing it now, like the way we talked about, in the typical brick and mortar setting, just wasn't going to work to tackle a disease that we need to treat. And again, not just from an individual standpoint, but, we think about countries that have figured out a way to handle communicable diseases, like infectious diseases and things like that. But they're now starting to encounter, sort of, Western diseases, like diabetes and heart disease. And, you know, sleep apnea was one of those, again, those diseases that if you can prevent or treat, it can prevent those problems down the road. So it's not only, it'll have an effect on health systems even, and how can we truly address this? So... I also learned that although people don't have sanitation in their home, some people, they might not have running water in their home, 80-plus percent of adults have a smartphone in the world. So there are smartphones and there's connectivity. And so, when I thought about how to tackle sleep apnea, a disease, as a disease and a population health type of process, I said, you know, we have to be able to do this through a smartphone. And that's kind of what got me thinking. And, you know, I went in, and I talked to some people about, you know, how hard is it to do this? Because I think I've told you this before, before I started on this journey myself, the amount of software development I knew about was how to download an app to my iPhone. I didn't know much about it at all. I knew my kids took some coding classes in their high school and college, but other than that, I really just didn't know a lot about it. The process, what you needed to do to, to create a good experience for a user. So. I did a lot of reading. I talked to a lot of smart people. I talked to a lot of people that told me that I was absolutely crazy for trying to do this, and that I shouldn't, and I should stick to what I'm good at, which is, you know, seeing patients and providing good medical care. But I really wanted to do this. I wanted to make a difference, and I wanted to see if what I thought I could do could happen. And we're getting there. We started the process. We're treating more and more people every month. It's becoming more accepted, and it's exciting. It's exciting to see this come to fruition.

Clinton: If I have to pull a moral from there, or the story there, is... If enough people are telling you you're crazy, you're probably on to something, right?

Daniel: (Laughs) Yeah.

Clinton: So... And good for you too, to... It's not just stick to it, it's just, it's just the belief that, and the faith that, no, even though you didn't know the exact path, you could still see a vision for, hey, I could envision a future where this many more millions of people maybe, maybe even into the billions, because of the platform that is the mobile phone, right? That, that was the platform that could enable this to go where you just, you simply can't go with urban sleep centers. Like, you're not going to build enough of them to, you know, help that many people. It's just, it is a, like, a physical impossibility. You can't build them quick enough and have the resources to do it. So, kudos for for that. And I do want to also have the audience understand... You know every nook and cranny, I would imagine, of the sleep world and sleep apnea and what does happen in those sleep centers, and what kind of, what are you trying to look for and what are you trying to collect? So how the heck do you start to look at the digitization process and say, well, what do we go do first? Where do you begin? Like, how do you filter down and say, an MVP in your world has to do X? If it doesn't do that, we didn't hit the mark.

Daniel: The most important thing is that you still provide a very high quality of care for a patient. Like, you don't want to take the brick and mortar standard of care and minimize that, or take shortcuts in the virtual space. So we needed to think of a way to take the high. Quality of care and a standardization of care and bring that to Ognomy, but at the same time make it a user experience, like an Uber experience.

Clinton: Yeah.

Daniel: That takes a lot of work. And the way we did that, and the way we started to do that, was to bring a whole group of people together. And different stakeholders, right? So we brought people together that worked in the sleep center. We brought together my kids, you know, that hang out on their smartphones a lot. We brought together some web design people. And we all sat in a room for two days. And it was a two-day, just, foray into the depths of what we're doing in the brick and mortar center, and what would be feasible on a smartphone. And that's what started the process, and it was really interesting how we created this, this team of people, too. I mean, it was... We had to have different personalities working together. We have people that are detail-oriented people, people that are visionary-type people. Because you need all those types of things when you're creating a new digitized process of something that's already kind of existing, but you're trying to change it, and you're trying to make it better. And you're trying to take away all that friction and, and the fragmentation that's occurring in the brick and mortar space and make it better. You know, so...

Clinton: Yeah, for sure. And what was the one or two, like, features that you were able to start? Again, like, I'm sure you've expanded, but you were able to take from the sleep center and say, okay, we can absolutely digitize that. Like, that's a core competency of what the app will provide. Can you give a little flavor onto what... what are the core things that Ognomy does provide via the mobile app?

Daniel: Well, one of the things is just the face-to-face visit with a sleep medicine provider. So, we had to make sure that you're able to engage in a proper dialogue with the patient, be able to do an exam through a smartphone. You know, where they hold the camera to the back of their throat so you can see the posterior airway. There are all these different things that you want to be able to do, to do a good physical and to do a good history, and to make sure that you're getting the adequate data to, then, recommend a diagnostic test. Instead of using the in-laboratory testing, home testing has been around for a really long time, and there are some really good FDA-approved type three home sleep tests out there that make the diagnosis of obstructive sleep apnea very well. I mean, the patient has to have a high pre-test probability of having it, and there are certain things that you want to see when you use that particular test, and it does have its limitations. But we in Ognomy are virtual first, and we use that home testing as our diagnostic tool. So, those two things were paramount to Ognomy. Having a proper evaluation by a sleep clinician, and then having a good diagnostic tool to make the diagnosis. And...

Clinton: Right.

Daniel: That was the first thing that we wanted to make sure that we had in there. And, you know, just wanting to do those things, you'd think that would just be simple. But, you know, to get... To get from point A to point Z, you know, that's how long it took to really even just get that MVP out, to be able to do that.

Clinton: So those are some of the core competencies as you, as you took it, as you got going. And, really cool to understand, look, you also leveraged existing home technologies, like you said, home kits that were, that were quite good. And also, again, the accessibility, right? It's like, hey, if you pair that with mobile to remove that other piece of friction, to start the process of, can I talk to a doc, and can I, can I get a... basically the thumbs up, say, yeah, you really should go get this test. And then you leaned into something that was already existing to then accelerate it further. Right there, just those things, you probably opened it up to nearly... I don't know how, percentage-wise, how many more, but nearly the maximum amount just there, who could take a much easier step forward. Which is... Which is really cool. That's a sign that, hey, you're on to something. You removed so much friction just with that MVP state. Then, what happens next? How do you, how do you look at your, I would call it, like, a wish list, right? How do you look at your wish list and say, oh man, this is the next thing. This is the next piece of friction that we really want to remove. Or, value add we want to put into the app as it becomes more, maybe, of a platform play. How does that evolve, and how do you go through that process with a small team?

Daniel: You know, sometimes it's the external forces that drive it. Some of the capacity, you know, and trying to drive volume as a company, you have to think of yourself as a company, as a business, in addition to, sort of, a medical team trying to address a problem. So, you have to look at those two in tandem, and kind of make a decision and look at your roadmap and what you should choose first. So you're absolutely right there. But, for us, we wanted to, kind of, what's the next step for a patient? And the next step for a patient is therapy. So once you make the diagnosis, there's still a lot of fragmentation in the therapy piece. Where, you know, you see the doctor. Says, yeah, it looks like you're a good candidate for that CPAP mask. Now you gotta go see a home care company, or, they're called durable medical equipment companies, and they'll get you all set up. So. We have to rely on the standard of care of that home care company, the quality of care, the patient experience of that particular company. That's not always so great.

Clinton: Here's the jump, which, to jump in, could be a huge variance, right?

Daniel: Yep.

Clinton: That's another giant variable that, it sounds like you are able to say, okay, we could... call it, homogenize that, to the positive, right? We can make that simpler and better and more effective and more consistent, through, again the application of a... digitizing that. So how do you do that? What's the... Do you get them on board with you? How does that actually happen?

Daniel: You know, if... We didn't want to be a home care company. We didn't want to treat patients in the therapeutic realm. We wanted to bring in these companies into Ognomy, create a platform for them to engage in this virtual care. But for us to also follow their care. And that's, when you talk about a platform play, we are all data geeks, and the way we set up our platform, we made sure that we were gonna keep a layer of data analytics to watch the patient journey, to see how quickly they were seen, how quickly they were set up on a proper equipment, what their compliance rates are. Like, we can tell, like, how they're doing on their machine. Even though they're not our patient, and they're siloed from the BAA and all the HIPAA, like, necessity.

Clinton: Sure.

Daniel: But we now are able to see how well they're doing, based on the provider. So we give these therapeutic companies an opportunity to be on our platform, to see our patients, but to know that we want these patients to have really high-quality care. So we opened up the platform to them. So we started off with these home care companies, and now we're talking with dentists. So, dentists are another possible therapeutic realm, where they can come into the virtual space and do part of their treatment through Ognomy. So, we felt that that was a really important part of the Ognomy journey for a patient, and that's what came next.

Clinton: It makes a ton of sense. And you mentioned the word platform a couple of times there, because that is the evolution, right? Because you're... Yes, you have to be compliant, of course, with that data, and that's gotta be absolutely paramount, especially in healthcare, as you know, but way better than I do. And with that, there are ways, there are ways to do it. And then, once you have what is a platform that could be scaled for adjacent use cases, well, you could do some biz model reinvention and reimagination, which sounds like is astep that you and the team are taking, which is, which is really exciting. And as you got going, and as you evolved the app, to me there was, like, at least a two sides there, right? You had, you had to make sure this was great for the, I would imagine, the docs, and you gotta make sure it was really, really easy for the patients, and remove friction on both sides, make it enjoyable, make it better through digital. So, you know, it sounds like, after you got through the MVP, you went back and focused on that patient experience like you just described. What did you hear from some of the doctors? Were they like, were they still telling you, you're out of your mind? Or do they start to kind of see the light because you were simplifying and making it easy and enjoyable through a new mobile experience?

Daniel: Well, first of all, we're still trying to figure it out, right?

Clinton: Of course. Yeah.

Daniel: We're still trying to make it better. We're always addressing concerns that both providers and patients have, and we're always changing the UX and the experience for both, and we're making it better with each iteration. But it's always growing, and it's always iterating and it's always changing. But, like, from the doctor's perspective, what a doctor needs to be able to do is to be able to see a patient, write a note, order something, and have great follow up. That has to be relatively easy. So we made sure, like, from the doctor's perspective, that when they're seeing a patient in the virtual space, they don't hang up the phone and then have to call a secretary, or write something in a different chart, or, or have to call the patient back to get something scheduled. So, Ognomy is really just a national network of these providers, the diagnosticians, the clinicians, the therapeutic arm, and they're layered on top of this platform that's intelligent and it's cloud-based and it's always changing and iterating. But it allows... it facilitates that easy care for the patient. So. Doctors were telling us, this is amazing, because I can see a patient, I can order what I want to order. The patient takes action by themselves. You know, there's just this easy process. And then when they're done, they're done. They're not going home and having to write notes in the middle of the night and, you know, different things like that. So the physicians find it really nice in that regard. But also, they like the idea that they can see a patient from anywhere. They don't have to be in the office, their lifestyle might be such that they want to be in a vacation home or something like that.

Clinton: Sure.

Daniel: Where they can see patients. And they love that lifestyle aspect of Ognomy. So we... As we grow Ognomy and grow capacity, we rarely have trouble finding physicians that want to work on the platform. That's been nice. And then, from the patient perspective... You know, Covid was a real changer for us. And when you talk about moving fast, I think we had to move fast because, when Covid hit, we were right in the middle of our, of our platform development, and... We're like, wow, we really need to get this out here, like, now. And so, that's what kind of drove the team and doubled our sprint time. So. But, you know, patients... Patients still run into blockers. And, you know, we still kind of recognize even simple things, even on the UX side. When they're on a screen and they're ready to enter the visit, if there's too much messaging above and the enter visit button's, like, down below, or they have to scroll up to get to it, they don't enter the visit. So we recognize these things all the time, and patients give us feedback all the time, because they'll call our patient support phone line and say, I can't get into the visit, and we'll find out why, and we make adjustments there. We get input all the time. And even a lot of the... my colleagues in Ognomy, some of our investors, they're still like, Dan, why do you still see patients on the platform? You must be so busy, like, seeing patients, reading sleep studies, running Ognomy. I'm the strategy guy. You know, being... It's like, I get all kinds of intelligence being on that platform as a physician, seeing patients, hearing what they have to say. So, I... Based on my experience, and even my own pain points, it helps drive the development of the platform. So, I'll stay on it until, until it's done, and I don't think it'll ever be done. So... (Laughing) I'm going to be... I'll be on it forever.

Clinton: Probably not, right? That's the... the advantages and the, the, the promise of the platform, is that it can, it's not rigid. It can evolve. You can extend gracefully, and you can extend with velocity. When you expand and extend, you're actually helping more people, which is really cool and core to what Ognomy does. I do want to ask about the doctors, to go back to them. Do you find that practices and doctors get on Ognomy, and then do they hold it up as a bit of a... something that they then promote and say, hey, look, like, you should come to our practice, because we're the savvy ones. We're the ones using technology. Do you see that kind of flavor from the doctors out there, too, who really take it and run with it and make it a part of how they... how they attract net new customers to their practice?

Daniel: Yeah. And we see that on both sides. We see... And even just our business model, we have physicians that use Ognomy as a platform for their practice, their own practice, their own telemedicine play within their practice. And they do utilize it to market it. And, you know, they can get patients access a lot quicker, a lot easier using Ognomy. And they do their own marketing for that, along with some of our more global national marketing that we do. But we don't market for those doctors. We don't really do that. They're just using the platform, and however they'd like. But we found, and we talked a little bit before about capacity, we weren't growing quick enough for our partners. So there are people that send patients to Ognomy that needed us to grow faster, and the sales cycle to convince doctors that Ognomy is the greatest thing since sliced bread, and you should change your software and jump on Ognomy...

Clinton: (Laughs)

Daniel: It's just a little bit longer of a sales cycle than we had.

Clinton: Sure.

Daniel: Entonces decidimos... No podemos llevarlos a bordo lo suficientemente rápido, vamos a crear nuestras propias entidades que tengan, ya sabes, médicos en ellas. Al igual que, nuestras propias prácticas. Y aunque no son propiedad de Ognomy, están afiliados a Ognomy, se llaman Ognomy Medical, y hay cinco consultorios médicos diferentes en todo el país que contratan médicos para atender a los pacientes. Como un trabajador de gig. Ya sabes, ellos típicamente...

Clinton: Sí.

Daniel: Simplemente, sean cuales sean las horas que nos puedan dar, son profesionales de medicina del sueño certificados por la junta. Y, ya sabes, si quieren trabajar cuatro horas a la semana en la plataforma, ocho horas. Mencionaste a Uber. Es algo así como el Uber para la medicina del sueño, en cierto modo.

Clinton: Y todo se remonta al hecho de que es... Es una plataforma. Entonces cuando tienes algo que es flexible, puedes extenderlo y ofrecerlo de nuevas maneras, y luego estás aprovechando, ya sabes, en este caso, la gente va a estar como, oh, no vas a tener médicos y este nivel de médicos que podrían ser gig workers, porque a veces pensamos en gig como la persona que te trae la comida o algo así, ¿verdad? Donde está, esta cosa que tanta gente puede ir a hacer. Bueno, sí, y... También hay usos hiper-nichos de gig, donde tienes gente que tiene, que es muy selectivamente calificada, que tiene un cierto nivel de capacitación y educación, y ahora estás proporcionando una nueva vía neta para decir, oye, oye, si pudieras recoger 3 o 4 horas a la semana e ir a ver, lo que sea, la X cantidad de pacientes que es... ingresos incrementales para ellos, más gente atendida en tu plataforma, más gente poniéndose más saludable. Realmente, realmente genial extensión del valor ahí, y a cuántas personas podrías servir. Me encanta esa parte del arco.

Daniel: No, solo iba a decir, y realmente ha ayudado a nuestra marca, la marca Ognomy, porque realmente no podíamos controlar la calidad de atención que esos proveedores que estaban usando el nombre Ognomy y la plataforma Ognomy. Pero ahora podemos. Entonces ahora que podemos contratar a nuestros propios médicos, podemos tener ciertos requisitos, podemos tener ciertas cosas que queremos asegurarnos que los pacientes experimenten que sean diferentes. Entonces, a medida que construimos nuestra marca, queremos que nuestra marca sea la mejor jugada. Y para poder hacer eso, tenemos que brindar la más alta calidad de atención. Y por suerte, ahora mismo, los médicos que utilizan la plataforma para su propia práctica, son fenomenales y hacen un gran trabajo. Y, pero... Había algunos duds, y nos preocupaba mucho que siguieran en la jugada.

Clinton: (Risas) Claro.

Daniel: Pero ahora nosotros, mientras impulsamos los grupos médicos de Ognomy, eso realmente nos está ayudando a mantener la calidad que queremos.

Clinton: Sí, así que no solo la reproducción de volumen, sino también el nivel ascendente de la calidad, como dijiste, por transacción, por así decirlo. No ser así, ya sabes, metódico al respecto.

Daniel: Pero es transaccional. Si. Absolutamente.

Clinton: Sí. Muy, muy genial historia ahí. Y luego, siempre me gusta preguntar a los invitados, sobre todo cuando están impulsando nuevas tecnologías y tienen un juego de plataforma ellos mismos: ¿Qué buscan? Ya sabes, ya sea dos años, tres años, cinco años, ya sabes, tal vez diez años, tal vez... Sea lo que sea para tu, tu horizonte. ¿Existen tecnologías específicas en las que tienes tus ojos puestos? Eso son como, ooh, eso es interesante. Podrían ser megatendencias, podrían ser tendencias de nicho, que estés... Al menos tener los ojos puestos, eso digamos, esto podría impactar o podría ser una extensión de Ognomy, si pensamos críticamente sobre, ¿cómo aplicamos esto? ¿Hay alguna cosa en el horizonte que te entusiasme en el equipo?

Daniel: Bueno, lo realmente genial de Ognomy es que somos agnósticos a cualquier herramienta de diagnóstico, a cualquier terapia. Siempre podemos iterar, cambiar, ampliar nuestra plataforma para traer eso a ella. Entonces, incluso de la manera en que diagnosticamos la apnea del sueño con una prueba de sueño casera, ya la hemos cambiado dos veces basándonos en la tecnología. Si están saliendo algunos más nuevos, nos gusta más, podemos cambiarlo. Pero me parece que ahora mismo, el mayor problema que tenemos realmente viene en torno a la gestión del ciclo de ingresos para los pacientes. Y esto suena un poco raro, pero es conseguir que los pacientes sean autorizados y aprobados para su atención. Porque queremos mantenernos dentro del modelo basado en seguros. Si bien ofrecemos autopago, es tal vez el 2% de nuestra población de pacientes. Los pacientes tienen seguro, deben usar un seguro para su atención médica. Queremos asegurarnos de que brindamos eso dentro de un paraguas de seguros. Pero eso es increíblemente difícil de navegar, conseguir que los pacientes preautoricen, que sus estudios del sueño sean pre-autorizados, para que se autorice su terapia, para saber cuál es su copago, su coseguro, qué van a necesitar. Y para asegurarse de que todo sea transparente. Es algo que los pacientes deben saber de frente. ¿Cuánto me va a costar esto personalmente? El costo sigue siendo importante, obviamente, para mucha gente, incluso en el cuidado de la salud. Entonces, queremos asegurarnos de que los pacientes tengan eso. Así que... Y, ya sabes, la IA es lo más genial en este momento. Pero desde una perspectiva de atención médica, no tanto sobre cómo la IA va a ayudar a tratarlo. Ya sabes, es más como, ¿cómo va a ayudarte la IA a llegar al tratamiento de una manera con la que te sientas cómodo y transparente? Entonces, estoy viendo muchas de las tecnologías que están usando OCR, o reconocimiento óptico de caracteres, y diferentes tipos de cosas para... Al igual que, pacientes, cuando suben su tarjeta, podemos decirles en un instante, como, cuál va a ser su copago, cuál será su coseguro, cuál será su costo de visita. Entonces, estamos viendo esa tecnología. Y luego, hay algo en medicina llamado el monitoreo del paciente, donde podemos meterlos en terapia y como que observarlos de diversas maneras para medir su nivel de cumplimiento en tiempo real. A esto se le llama monitoreo remoto de pacientes. Estamos viendo que se concretan más. Y así, hay algunas tecnologías alrededor de eso que estamos buscando incorporar a la plataforma. Desde la perspectiva de la apnea del sueño, simplemente estamos emocionados de que finalmente esté en la pantalla del radar, y la gente esté buscando diferentes formas de tratarla. Ya sabes, de CPAP, ya sabes, uno de nuestros realmente grandes socios se llama Inspire Medical. Tienen un dispositivo que es un estimulador nervioso, con cada respiración avanza la lengua hacia adelante. Y está destinado a personas con apnea moderada a severa que realmente no pueden usar la máscara de CPAP, y es muy eficaz en muchos pacientes. Entonces, solo los avances terapéuticos son emocionantes. Incluso hay algún medicamento ahora que, se está probando, y podría haber una pastilla para la apnea del sueño. Eso sería... Esa sería, de nuevo, una manera de abordar a los mil millones de personas en el mundo. Esa será la forma más fácil de abordarlo, si pueden encontrar un medicamento para abordarlo. Pero Ognomy estará ahí. Aún necesitas un practicante que te lo recete. Entonces, a menos que se convierta en venta libre. Pero, sí, seguiremos iterando y creciendo cualquier esfuerzo terapéutico que venga.

Clinton: Quiero darle un enorme agradecimiento, doctor Dan. Nuevamente, CEO de Ognomy Sleep. Y doc, si hay oyentes que o lo sufren, creen que sí, tienen un ser querido que podría, ¿qué deberían ir a revisar? ¿Cuál es el mejor recurso al que pueden acudir? El único lugar al que te gustaría señalar a la gente.

Daniel: Bueno, obviamente, solo ve a OGnomy.com. O-g-n-o-m-Y.com. Es una especie de nuestra landing page. Puedes leer un poco sobre lo que hacemos. Hay algunos botones de llamada a la acción allí, si desea tomar medidas de inmediato para ver un documento de sueño. Entonces, solo dirígete ahí fuera. Pero, no. Abordarlo. No admires tus ronquidos por la noche. No admire el hecho de que su reloj muestre que su oxígeno está bajando. Quieres tomar acción. Y cuanto antes lo hagas, mejor. Entonces, gracias, Clinton. Muchas gracias por sus amables palabras. Siempre es un placer verte, y gracias por tenerme.

Clinton: Muchas, grandes gracias al Dr. Dan por acompañarnos en esta gran conversación de hoy sobre Catalyst, donde creemos que lo rápido seguirá sin problemas, y apuntar a crear experiencias digitales que muevan millones -y, en el caso del Dr. Dan, quizás miles de millones- es una búsqueda muy digna. Únase a nosotros la próxima vez mientras la búsqueda continúa en Catalyst, el podcast Launch by NTT Data.

(CATALIZADOR DE MÚSICA OUTRO)