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Growing Lean
Exploring the Future of Digital Healthcare with Sujith Krishnan and Metronomic
Meet Sujith Krishnan, a visionary surgeon-turned-CEO who's revolutionizing the healthcare industry with Metronomic, a groundbreaking digital health platform. Step into the fascinating world of health tech as Sujith shares his journey from the operating room to the boardroom, and his ambition to redefine healthcare through predictive analytics and automation. Discover how he's leveraging cutting-edge technology to deliver personalized care plans and improved patient outcomes.
Strap in as we explore the inception of Maternal, Metronomic's maiden product, crafted to enhance the pregnancy journey for expecting mothers. The conversation then navigates towards the future, envisioning a world where routine medical scenarios are automated, freeing clinicians for more complex cases. Are you ready to imagine a pocket-sized scanner capable of diagnosing us with a single blood sample? Sujith is, and he's excited to delve into the endless possibilities of AI.
Our conversation culminates with Sujith sharing insights from his professional journey, chronicled on LinkedIn. Learn how he faced the challenges of building a remote tech team during a pandemic and his endeavours to find the right product-market fit in the U.S healthcare system. Join us as we explore the potential impact of automation in routine medical situations and how Sujith's vision could reshape health tech. Let's tune in for this exciting journey into the future of digital healthcare.
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Welcome back to the growing Lean podcast sponsored by Lean Discovery Group. This is your host, dylan Burke, also known as Deej. I'm very happy to be here with Suggish Krishnan, founder and CEO of Metronomy. Hi, dylan, nice to be here.
Speaker 2:Good to have you here.
Speaker 1:So, to get us started, can you tell us a little bit about your history and background and how you ended up in the business you're in today?
Speaker 2:Sure, thanks for the opportunity. Yes, like you said earlier, suggish Krishnan, I'm actually a medical doctor. I used to be a surgeon in my previous life, so I did basic surgical training and neurosurgical training in the UK Ages ago and then I kind of pivoted to do an MBA, to get into the business side of healthcare and as part of that I started with new technology that kind of is relevant for healthcare. So I've been in the healthcare technology space the last 20 years or so, working for the companies and doing a couple of small startups sort of gigs myself. So this business that I set up now is about three years old. What we're building, what we are, is a digital healthcare company that builds platforms for specific conditions, and so our first product that we launched is called Maternal, which is focused on improving the sort of experience for pregnant mothers as they deal with their OBGYN group. Focused on the US market. I was based in the UK and I moved here in October last year because the platform and the business we're building is very US focused.
Speaker 1:Okay, amazing. So the maternity side. That's just the first of many, I assume.
Speaker 2:Yes. So what we're trying to do is to build specific expertise and platforms around one condition and maternity is a very, very easy to define condition so you can build the protocols, you can build the evidence-based guidelines for it and see how that improves outcomes. Our long-term plan is to then take that experience and focus on other conditions as well, like chronic diseases like diabetes and hypertension and obesity. So we're starting out with Maternal and then we plan to pivot and extend the platform into other areas.
Speaker 1:Okay, amazing. And is the plan for this to be used by doctors or by the general public?
Speaker 2:I believe that everything in healthcare eventually should be connecting the doctors and the patients, because they are the two key stakeholders in healthcare Technology, and everything you build should actually strengthen that relationship. So we're not trying to disrupt the doctor-to-patient relationship. What we're building is a platform that allows doctors when I say doctors, I mean the whole healthcare community that delivers your care, allowing them to deliver better patient care, improve outcomes and, for the patients and the people consuming it, the idea is to kind of get them on the same page as far as information is concerned and let them know what they need to do, and so they're both thinking on the same hem shape and they can eventually focus on what's more important for both of them, which is better outcomes for the patients in that sense, and so it's going to be something that is delivered through the physicians and the groups to the patients.
Speaker 1:Okay, amazing, and could you walk us through your overall business strategy?
Speaker 2:In terms of the platform and what we're trying to do, as we're focused on the market here, which is the US market, which has got very specific characteristics compared to others. It's a very insured instead market. So the way our platform works is to allow physicians and groups to deliver care that eventually is insurance reimbursable. We allow them to monetize certain things that they wouldn't have thought of. We're going to find the specific codes that will allow them to deliver better services, and so our business model is around offering it to the physician groups and eventually even to insurance, on a per patient, per month model. So it costs a certain amount to onboard the platform and run it, so it's no direct cost to the group, to the physicians, and also no direct cost to the patients. It'll be paid for eventually to the insurance reimbursement.
Speaker 1:Okay, that's amazing. I'm excited to see what comes from this. It's super exciting, absolutely.
Speaker 2:The longer term goal is even more exciting, because it's better patient care, better outcomes and, eventually, lower costs. As you know, in America the total healthcare spend is about four and a half trillion dollars right now, which is obviously a lot of money, but the quality of care that comes out of it is not as good as the amount of money that's spent. So there could be a lot of things that have done better, and so we're focusing on some of those aspects.
Speaker 1:Amazing, I love to hear it. And so what is the biggest problem you've consistently faced in starting your business and how have you solved it, or how are you solving it?
Speaker 2:I guess the biggest problem with any of these things is to find the right sort of product market fit. There's lots of good ideas, lots of technology available and if you know in America I'm sure you know there's a lot of the big tech companies have tried to get into healthcare. Everybody from Microsoft, google, amazon they've all put their hand in and tried to do different things in healthcare. They've tried to disrupt the story. Silicon Valley is always happy to kind of get in and disrupt using technology.
Speaker 2:None of them have succeeded because obviously it's a big industry, there's a lot of stickiness, a lot of existing stakeholders with entrenched, you know, sort of interest, and so getting them to change, move the needle a little bit and sometimes some of these things is not easy. And so I guess the biggest challenge we face is the whole maze of how the healthcare ecosystem is set up and navigating that is very, very difficult and that takes a lot of time. So for any startup trying to kind of operate in the space, getting in there, understanding the whole ecosystem and understanding how to go about that consumes a lot of time. A lot of companies give up, even the big guys give up, even the ones with deep pockets, because it's not easy to survive and sustain and continue. So it's you need a lot of resilience, and so those are sort of things we learn as we go along.
Speaker 2:And the other thing I suppose to bring up is the is the education and the sort of information that's required to convert, like the physician group, because they they're obviously very, very stretched for their time and there's limited amount of time and effort they can put to any new initiatives of the thought we bring in and so convincing them, you know, in those few minutes to try and look at something new is not easy, and so it takes a lot of time and effort to kind of get them on board. But then I suppose so that's kind of where the startup challenges, and so that's kind of what we're focusing on building the technology, getting the technique together, raising the funds all of that is not too difficult. It's a question of acquiring the rights of customers and then getting more of them to buy into your vision of how something like this would actually make a difference, and that that's a challenge. That's kind of what we're working on.
Speaker 1:Okay, cool, and I'm sure having a history as being a surgeon has helps you get in front of physicians, so you're not just some random person coming into the scene. You actually know what you're doing, you because you qualified, you know. Does that help?
Speaker 2:Absolutely. Actually, because physicians does not trust other physicians, and so if you're a tech person selling something to them, they don't trust it as much as a clinician telling them. And so I've been on both sides. I've obviously been on the clinical side of it, I've obviously been a patient, so I understand some of these things and I've actually been in healthcare technology now for 20 years so, and I understand the business and economics of this, and so for someone like me, I'm bringing a very well-rounded perspective on these aspects and the conversation with physicians is a little easier than it would be if I didn't have those sort of experiences to call on 100% and how have you adapted?
Speaker 1:You say you started three years ago. How have you adapted over the last three years, especially like coming towards the end of COVID now with this whole AI revolution? How have you adapted to the changes and are you making use of any new tools that are available? Yeah, I'd love to hear what you've been doing.
Speaker 2:Absolutely yes. So we started this out kind of just about when COVID was starting, and so our early part was very complicated and I don't know if you remember the greater part of 2020 to 2021, we weren't allowed to travel from the UK to the US. There was a travel ban because of COVID and so we had to do everything remotely in those days and so even as we started building out the team, like our tech teams based out of India, we've got about 25 people there who are working more remotely. There's nobody who's gone into an office at all in the last three years and they're all working in their homes in different parts of the country. So there have been lots of challenges and, like I said, covid didn't allow travel, so the initial part was very, very difficult actually in testing out some of these things. You couldn't go and meet your customers or potentially your customers. So till COVID kind of opened up, made it a little easier and since 2021, when we were allowed to travel and then you could go and meet potential customers and show them what you're building, and so that change helped when things eased out a little bit.
Speaker 2:In terms of new technologies, yes, our long-term goal really, which I didn't kind of touch on earlier was to build predictive analytics algorithms that would allow us to predict this more accurately. So all of this that we're doing is kind of a means to an end. What we want to really do is to be able to stratify patients more effectively. Looking at a patient, we want to be able to say whether he or she is going to get a complication or not. So we're working on the AI for that, which is a very, very long-term process. It'll probably take seven to 10 years before we have anything that's meaningful. So in maternity and pregnancy, what we want to really be able to say is, when the patient comes in week eight or week 10, we want to be able to say her risk of getting gestational diabetes is 90%, or risk then she might have a C-section, which is 90%.
Speaker 2:We want to be able to predict those, and so that's something we're working on with the AI tools. We're using certain elements of chat, gpt and things like that, as you would imagine, for some of the interactive responses, some of the things that we would deliver to our patients. But the long-term goal is around having very, very accurate algorithms that would actually do prediction very effectively. And then automation is something we do a lot of, because our sort of modules are based on care plans that are automated, so things like routine services can actually be drawn on autopilot. In that sense, 70% of patients would not need anything that's out of the ordinary, so you can actually automate the process for them. So, like what UI path does in a process automation, we kind of achieve that in the clinical side by building sort of automation into the platform, and so we're using some of these new sort of learnings and technologies and the way we build and the way we deliver eventually to the patients.
Speaker 1:Amazing, that's amazing. And how do you measure the success of your business? Do you have any specific KPIs?
Speaker 2:I suppose, like I said, our longer term goal is actually better outcomes and we have specific anecdotes of examples that we have. We haven't done detailed studies to kind of understand how, using our platform, for instance, maternal, that we have delivered and launched in various parts of the US how that's going to improve outcomes. We don't have a long study, but then we've got so many examples of patients having benefited from using it. Simple example If you have a risk of hypertension during pregnancy, you have a risk of what's called preeclampsia, which is a very, very bad condition. Now, if you can stop that, or if you can predict or see that something is happening let's say you're monitoring a mother whose blood pressure is going up. If our care managers can pick it up, bring them into hospital early or clinic early and stop it from becoming what is called preeclampsia, which is actually very difficult to treat, you can actually save her life. You can save her baby's life. So those are the sort of things that we're looking at. How can we improve outcomes? How can we ensure that the numbers that are getting complications Like?
Speaker 2:In the US the risk of complications is almost 20% among pregnant mothers Now can you reduce that by half a percent. Those are the sort of things that we're looking at in our population and that's kind of what's going to define success for us. Can we actually say that, yes, we've reduced the chances that someone might get a C-section out unnecessarily, or someone might have a preterm delivery, or someone might have preeclampsia and aneclampsia? How do you prevent those risks and how can we measure that? There are obviously monetary considerations. There are revenue numbers, all of that we look at. However, I suppose the long-term goal is really patient outcomes.
Speaker 1:I love that. High impact entrepreneurs are my favorite type of people to interview, because you have more than money at the end of the day as your goal, and I think that's super important and admirable. I'll just notice so you said you were a doctor and then you studied in MBA. Where does your tech background come from? Have you formed any collaborations or partnerships in terms of the tech side of the business, or how is that working?
Speaker 2:I haven't really. I can't do hands-on coding, I've not really gotten my fingers dirty in terms of those things, but I've always been interested in technology and I understand technology, I suppose because I have a natural flair for it. The reason I got very, very interested in technology was during my MBA. I actually did a little bit of work with a company called Cisco Systems, which is ages ago In those days. This is the start of Internet Revolution and Cisco was actually the biggest company by market cap in those days. We did a little bit of work looking at newer healthcare technologies that were available, trying to see what we could bring from America to the UK. The UK had a lot of push-around technology in those days. That's how I got interested and involved with the technology aspect of healthcare and since then whatever I've done has been connected to the business and the technology side.
Speaker 2:Although I'm not a technologist myself and I can't build code, I've been able to recruit and find the right people to do that. My team doesn't have a co-founder mix that has technology expertise, but I've actually built a platform that is amazingly effective using the rights of technology people. Because I've been in the healthcare technology and outsourcing site for many years. I understand how to build lean teams, low-cost teams, to build a tech that you want. I think I'm good at communicating what is necessary from a functional perspective to the people like you, writing the code that helps me build platforms like these at a very, very low cost. If you had to imagine building a platform like internal in America, it would cost you several millions of dollars, but we were able to build it for a fraction of the cost because a large part of the tech team is actually based in India.
Speaker 1:Yeah, 100%. That's why I'm working from Cape Town and not US citizens. The cost arbitrage Right. So where do you see the health tech industry heading in the next 10 years? Because we're obviously at a pivotal point in technological evolution. So I'm assuming in 10 years, like what we see as going to the doctor or going to the hospital today is not going to be the same at all, and I'd love to hear your thoughts on that.
Speaker 2:Absolutely. I think there's going to be a lot of automation and you know I don't want to use the term AI Because it's a very abused term. I don't think there's real AI yet anywhere. I don't think the responses are something the machine is automatically generating. It's only doing it based on learning. But I suppose even human sort of responses are based on our learning. So it's similar in that sense.
Speaker 2:But I think 60 to 70 percent of medical situations are Are easy to template eyes and so, like you go to the doctor with a cough or a cold, it's not something that you really need a human for because the, the protocols are very set. Similarly, in pregnancy, routine pregnancies without any sort of you know outline factors, without any comorbidities, could be treated as a routine automated case. And that's kind of where I think the will be, where the machine takes care of 70 percent and the human only gets involved in the 20 or 30 percent, which is very, very complicated and needs their intervention, because the humans will still continue to to deliver things that are, that are not predictable, where there's an issue suddenly that props up, which where the machine can't take care of those things. So I think that's kind of where healthcare will go. Technology will be used to automate and make life easy in routine situations when the clinicians with their expertise can actually, you know, focus on the ones that really need their time, and the other thing is about taking the learnings of the best ones and putting it into the machine.
Speaker 2:So if you can actually have all the latest evidence and guidelines in your app, then you don't really need to worry about missing things. You know that everything is being taken care of and you know you're doing the best clinical, delivering the best clinical service possible, and I think that's technology is going to help with that a lot. I don't know if you'll get to the stage of Star Trek and the transponders and canning and getting picking out things. They'll probably take another 10 or 20 or 30 years Maybe, but then I think a large part of what you see now will probably be automated and We'll probably find that Technology is kind of helping out in easing the time burden of the patient and clinicians 100%, and I'm glad you mentioned the sci-fi aspects because I remember as a kid watching Sci-fi movies and seeing people with ailments going to a little scanner.
Speaker 1:They come out and they'd know exactly what's wrong with them and that always seemed so far fetched to me. And now it's like it's starting to seem real with the technology we're. We're getting now, obviously not any time like in the near future, but we're getting close and it's really exciting. It's also exciting to see that it's obviously going to be able to extend the lifespan of the average human if the technology gets to that point, and it's just going to be a super interesting time because there's just so much going to be happening. I'm excited for it.
Speaker 2:Absolutely, absolutely. I mean, life is going to get exciting. In that sense, I think technology is going to make I think technology is already making a lot of our lives easier. You know everything that we do in the house, too, and I can't wait for home robots to actually empty the dishwasher and fold the laundry. I think those things make life easier for a lot of us.
Speaker 2:You know self-driving or self-flying cars. They'll take us from A to B without having to worry about, so you can actually have a drink and then come back home without calling an Uber or a version of Uber, I guess. So, similarly, in healthcare scanning finding like there's a company called TerraNOS which was trying to do all the tests with a fingerprint, fingerprint sort of blood sample which went under. But the idea was that right, if you can go into a clinic and get an analysis of everything instantly, which now takes like a few days or a week, that's hugely beneficial. Now, if you have a small, pocket-sized scanner that can actually look through you and tell you what's wrong, those things will happen with AI and new technology and it'll make predictionally, make therapy a lot, lot better and easier to handle for everybody 100%.
Speaker 1:And then back to your business. So if I were to ask you to rate your level of satisfaction, where you are in terms of business, on a scale of 1 to 10 today, what would that be and why?
Speaker 2:I would probably give it a 4 or a 5 right now, because we have a lot more to achieve. We have hardly scratched the surface with regards to some of these things. I mean one of the biggest things I can tell you maternal mortality in America is a very bad sort of statistic. It's one of the worst in the developed world. So much money spent about $125 billion is spent every year on complications for maternity. That's a huge amount of spend for a population of 3.7 million being delivered in a year $40,000 an average spent for pregnancy.
Speaker 2:Without the results you want, and so we're not really there. There's a lot more work for all of us to do to actually get to a level where we're improving outcomes, and so we want to be able to get there, and that's why I think it's a very early process. 4 or 5 is where I think we are. We need to get to 9 or 10. With a lot of these things that we're doing, we're hoping we can cover a significant number of pregnancies. We're hoping that every mother gets remote care and remote monitoring. All of the data can flow, the technology exists, the money is there. It's just a question of, you know, wanting to do some of these things and converting a lot of these stakeholders to your side of the fence in terms of understanding how much of a difference it can make, and so that's the answer.
Speaker 1:Okay, amazing. And if we were to meet again in 3 or 4 years time and ask the same question, what would you want the rating to be then?
Speaker 2:I'm hoping in 3 or 4 years, we can have a level of satisfaction of 8 or 9 at least, of having achieved some of these things in certain areas and then moved on to certain other areas, because we're not just happy with what we're doing in eternity. We want to do other things. My long-term goal was to build a sort of ecosystem of condition-specific apps and platforms that will eventually deliver better outcomes for everybody, and so we want to get towards that ecosystem, the disease management sort of frameworks that will allow a lot of the process that we automated and eventually, for patients and doctors to be on the same page with regards to what needs to happen. And so that's hopefully where we're heading, and I'm hoping that I can say that, yes, we've achieved a bit more of what we wanted to do.
Speaker 1:Okay, great, I love that. And are you looking to continue this forever, or are you looking to get to a point where you can exit with a significant amount?
Speaker 2:Not really. I'm not looking to exit. This is kind of what I want to do. So this is not. I'm not in healthcare to make money. I'm obviously in healthcare to make a difference and so obviously the money is great, but it's not really for the money. It's not. This thing that we're doing has actually got a bigger purpose and we want to be successful in ways. I want to actually build a hugely successful digital healthcare company and I want to run it. I'm only 50 years old. I still have a lot to give and I don't, yeah, exit from the business is not. I mean for me personally. Obviously, my investors and all that would benefit from certain things we do in terms of the certain rounds that we do or a way to kind of compensate them for their investment in us early, but for me personally, no, I don't think I'm looking at an exit next 10, 15, 20 years.
Speaker 1:I love that answer. Thank you for that and thank you for being on the show. We are running out of time here, but before we go, what advice would you give to other business owners looking to succeed in your industry?
Speaker 2:I think the biggest thing that you need to do in healthcare to be successful is to have patients and understand that it's not a Facebook sort of you know built, part and break area. So in healthcare you need to actually build slowly and test it out, and so it takes time. It's going to take seven to 10 years to build anything substantial or substantial, and so you need to find that patient within yourself and you need to find that that's a patient investor, because I think you need patient capital to actually build something significant in healthcare, because you're not going to get results in a few years and things like that. It's going to take time and so it's got to be. People are willing to look at this for the longer term, and I think having that patience and perseverance is probably the most important thing that you need to be successful in this area.
Speaker 1:Amazing. Well, thank you so much for being on the show. I've really enjoyed our conversation and picking your brain a little. What would the best way for people to either reach out to you or to follow Sugita Krishna, and, if you have any offers, or if they just want to follow your story and see where you're heading, what's the best way for people to follow you?
Speaker 2:LinkedIn is kind of where I do a lot of stuff. I'm not really on to any other social media networks. I'm very professional, so I kind of post articles there, I write things, so the best place would be LinkedIn.
Speaker 1:Okay, amazing. Well, thanks again for your time. I've really enjoyed this conversation a lot more than I thought I would in terms of healthcare, so thank you for your time and for your knowledge.
Speaker 2:Absolutely. I appreciate the time, Dylan. Thank you for inviting me.