#535 - Why is chronic disease still winning? | Mark Clermont (CEO, Cecelia Health) & Wendi Mader (CCO)

Speaker A: Thank you both for joining me on the Slice of Healthcare podcast. We're gonna go a little bit back and forth. So Mark, before we go into Cecilia Health. Of all the problems in healthcare you could have built a career around, why chronic and specialty care and what pulled you into that specifically?

Speaker B: You know, I think this is uh, one of healthcare's biggest structural challenges. Managing chronic and cardiometabolic disease through integrated coordinated care instead of reactive, episodic and self driven interventions. You know, when you look at fragmentation across the healthcare ecosystem, we've all experienced it and you combine that with limited clinical resources, you combine that with evolving technologies and just this incredible invention of specialty drugs that are uh, having a massive impact on a chronic disease. And now we finally are at a point where historically the episodic nature of healthcare is now starting to push more fulsomely in terms of providing incentives to move upstream into the preventive space. And so all of that's deeply exciting at the end of the day. I remember someone had said to me, you know, the ideal life is one that's uh, certainly well lived, but also you have sudden death and double overtime as a hockey reference. In fact, you want to be playing, dancing, playing hockey, whatever, to the latest stages you possibly can and then not burden the system thereafter. And you have to focus on chronic disease to make that happen. So that's uh, that's always driven me, um, from when I was a young lad. I'm the, I think everybody has, has heard some of my story before. I'm the son of a, of a surgeon and watching dad work as, as just stopless hours all in the name of, of bettering patient lives and saving patient lives, that's a pretty healthy of motivation and I'm just trying to carry forward as best I can.

Speaker A: Wendy, now, over to you, same question. What's the experience on the, on the m or, or the moment that made this the thing you wanted to spend your career on?

Speaker C: Sure, probably. I would tell you about 20 years ago and I was, I happened to be a college athlete and I realized that if I didn't actually take care of myself, I wasn't going to have a good season and I wasn't going to be able to play. And I actually couldn't run the mile at a time that was what I was used to running the mile in. And it was very weird. Uh, I found out very quickly I was anemic. And from that it was a moment where I was like, well, geez, wonder what I could do. Maybe I need to eat healthier you know, there are just lifestyle things I needed to do to take care of that. And immediately I changed my career path directly into preventive care and, and things like that and, and you know, on the wellness side. But what I realized over the years, uh, where my path took me was very much into the clinical side of things. And this is what we're doing at Cecilia is super exciting because it's very clinically focused and we're able to help people who have chronic conditions and put them on the right pathway. But also, you know, one of my main goals over the path of my 20 plus year career has been we need to address the, the big issues in healthcare and make healthcare more accessible but also easier to access, like I just said. But also when you add in component components like cool therapies that are being launched and rolled out and AI and tools, it takes technology to bring those together and it takes people who are innovators to help the old healthcare pathway become the new healthcare pathway. So that's why I'm here. Um, I think there's just some really neat things we can do, um, and we're at a really neat inflection point, um, in reshaping care.

Speaker A: Walk me through Cecilia in plain English. So if I'm a patient with diabetes and high blood pressure and I become part of your model tomorrow, what actually happens to me that wouldn't happen in the system today?

Speaker B: Yeah, so, well, you know, so first, Cecilia, health help care organizations combat rising cost of care, uh, by managing chronic and cardiometabolic disease through clinically led lifestyle driven care, integrated care across comorbidities versus a single condition or a wellness program, uh, that includes medication management including GLP1s, from prescribing of medications or therapy to titration, to side effect management to optimization versus just getting a prescription, if you will, intensive nutritional therapy that spans personal preferences, cultural needs and disease state considerations versus compare that with rigid dietary regimens or predetermined or AI created meal plans, um, and then layer in there personalized lifestyle and behavior guidance with goal setting, digital tools, track progress, all those, all those fun things. And so we partner with healthcare organizations, life sciences companies, employers, payers to deliver personalized virtual specialty care for people who live with these conditions. And so what differentiates us at the end of the day, trying to pitch towards your question here, Jared, is what differentiates Cecilia is our clinically led continuous care model. It straddles. Think of, we'll get into some of these complexities, uh, coming up. Um, but it's a Unique evolution, I'll say, of virtual care. I joined this company in January of 2020, 2021. At the time we were running a clinical study to prove that diabetes management could be performed virtually. Sounds Pollyanna in 2026, but back then it was nouveau. And as part of that study it was backed by the, the Helmsley Charitable Trust. The company created a uh, medical uh, practice license licensed in all 50 states and then overlaid that with traditional care management and uh, or wellness ish programs. Connect all of those things and turns out you can effectuate at a lower cost of care delivery, you can effectuate more beneficial clinical outcomes again today in 2026. We take that for granted. But what Cecilia's done since then is we've expanded beyond type 1, type 2 diabetes, gestational, but then complemented with other specialties, all in the name of chronic disease and cardiometabolic conditions.

Speaker C: When we think about our mod, it is about a network of RNs, RDs, CDCSS, diabetes educators that provide oversight and care coordination. And so you've got clinicians that are supported by physicians behind the scenes as well in delivering care and supporting people through care. And I think the important thing to know is that brick and mortar can't do this. It is in care coordination with brick and mortar. But we are, we're an extension of primary care. When I came into the organization, it was important for me to understand that um, we wanted, we wanted, we didn't want to take away from the primary care physician and what they were doing. We actually wanted to support it or their primary physician that they interact with every day. I think one great example that I'll give you is we're working with um, some chronic conditioned, uh, chronic kidney disease patients that are on dialysis and we're actually supporting them from. Half of people who are on dialysis are diabetics. And many of those people do not have endocrine endocrinologists. They don't have the correct support that's required. And I know when I initially talked with Mark, it was very exciting to think about the fact that we can help people who have multiple chronic conditions and, or who are essentially high cost claimants, um, that will resonate with all employers listening to this, um, and essentially able to take them and support them more holistically. So the nephrologist who's treating the dialysis patient goes, I don't really know how to treat the, treat the diabetes, but I have support here from a company like Cecilia Health that can support those patients more holistically. To help them manage their diabetes, manage their dialysis and treat them more holistically. Really cool stuff that we can do as an organization that many who you would kind of say are like us, they aren't because we're uh, you know, multi specialty medical practice.

Speaker A: I want to shift focus a little bit and then go back to Mark and then Wendy. We'll go back over to you, Mark. The Commonwealth fund ranked the US dead last among 10 developed nations on healthcare performance last year. When you read a report like that, what's your honest reaction? Is it as bad as it looks or is it actually worse?

Speaker B: We're all patients and we've all experienced what it's like going to the emergency room or trying to get in to see a physician, even just trying to get a primary care provider is challenging. And so I can see where that frustrates people. And then again you all of a sudden you get this explanation, uh, of benefits from in the mail and it doesn't make sense. You see that the costs were $100,000 and then some negotiated reduction complements with your health plan brings it down to $10,000 but still it's $10,000 and you only went to the ER because you had a headache. And so yeah, it feels, it doesn't feel good as, as a patient and it's candidly, it's even worse when you have a chronic condition. If so because you, you also have to rely upon many of the reimbursements and funding mechanisms historically in US Healthcare haven't really favored preventive medicine or management of chronic conditions. Yes, there are some things there, but there's so many limitations placed around how that care can be delivered that uh, it just doesn't incent the right kind of behaviors. And again it's all very expensive. So do I agree with the analysis? I think it's probably a bit attention getting at the end of the day the US healthcare system, I personally wouldn't want to be treated anywhere else. And yes it's expensive but we have access to some of the most advanced medicine, uh, and therapies and facilities out there. And so I certainly uh, am very optimistic and bullish especially since there's so much change that's happening in this space. Certainly with the advent of technology, with the advent of a uh, renewed focus on preventive care with new acts, new models like access and balance and elevate and coverage for obesity within Medicare, all coming in 2027. It's an exciting time when you put that together with again technical tools, AI tools, everyone has more ubiquitous access to healthcare if they need it. And we're really at the precipice of this. And so as we're sitting here at Cecilia Health providing virtual care and then a layer, uh, wrapped inside that, that is an organizing layer, if you will, coordinating, uh, among different specialists. So whether you see one of our endocrinologists or one of our cardiologists, you'll also, if you have a primary, uh, care provider, we will coordinate with that primary care provider, et cetera. And so we bring that full care team to bear and do that in a convenient way. So to me this is. When you look at the rise of patient access, it's also a scary proposition. And uh, it's scary in the sense that this new GLP1 drug class, WeGovy, Ozempic, et cetera, is really highlighting the fragmentation, uh, and in fact exacerbating it in many ways. And so it's a, it's a scary thing because we, for example, we have a patient who came to us and they obtained access to a GLP1 or prescribed a GLP1 through one of the direct to consumer facilities. And, and that's fine. And they came to us on a high dose of, the highest dose of, of WeGovy. And they came to us because they were having extreme nausea, severe, uh, nausea, they were having a painful skin rash. And these are, these are side effects. Uh, and so they, they thankfully came to us and come to find out there was one other dangerous thing that the prescriber of that GLP one didn't realize because their, their intake assessment didn't know, uh, is that this particular patient also had major depressive disorder and had been prescribed an ssri, which it is, has uh, an appetite suppression side effect to it that medication does. And so when you put the combination of a GLP1 associated appetite suppression with someone who's on an SSRI, you need to have special understanding and familiarity with how to work with that patient. So thankfully, uh, our team, our care team very quickly was able to step that patient down off of that high dose, get them into a lower dose. The patient reacted well to that lower dose. From a cost of care perspective, not only is Cecilia Health delivering at a lower cost of care, but very, very importantly, that patient didn't end up in the emergency room because that severe nausea would have led to dehydration, which perhaps would have led to a combination of that plus malnutrition and all of that was avoided. So avoidance of, of ER utilization is a big facet of what we bring to the table each and every day. So anyway, I'm getting a little afield from your original question here Jared, about the comments about the US healthcare system. But reality is in the US healthcare system we can do the things that I just described and we have the freedom in our private sector to be able to do that. And so to me that's a very big win for patient care overall.

Speaker A: Absolutely. Thank you Mark. Um, Wendy, over to you. There's, there's a question I uh, keep coming back to and it, it seems like these days we have more apps, more digital tools, more wellness programs than we ever did before and chronic disease seems to be still winning. What, what did, without calling out anyone in particular, what did some of these other platforms out there, tools, apps, what do they get wrong?

Speaker C: So it's, it that, it's a great question because if, if I go back to the early days of, you know, wellness, well, being in the self insured employer space, right. You've got things like point solution, fatigue and you've been hearing it. I come back every day as a commercial leader of saying we're not a point solution. We're especially virtual medical practice and we practice medicine. What they got wrong is that healthcare doesn't, it needs, it needs to look at it from a longitudinal care situation because it's disparate care without coordination. Um, some of the really interesting things that we as an organization, because we are a, uh, medical practice, have access to is patient medical history. If I'm coming in and I find out that someone has a clotting disorder or something like that, that's going to drive weed to prescribe meds differently. A great example today is folks going on hrt. A lot of women today are going on HRT and there are a lot of women who have risk factors that can cause things like dvts, pes, uh, that shouldn't be being prescribed through channels where they're not aware of all the other risk factors that someone has. And so we've been trying to band aid patch all of the problems in healthcare for many, many years without saying, I'm gonna go sell, you know, I've done it, I'm gonna go sell a point solution into that employer that's just going to look at your pre diabetic patients and we're going to forget about the diabetics, we're going to forget about the type ones. No, we need to look at the population holistically on the diabetes, you know, platform and essentially say how do we help those patients from whatever condition they have. So that's been where it's gone, gone wrong. I'm not saying the tools aren't bad, uh, are bad, because I could tell you, every day we fought for more people to engage in those tools and get on the preventative pathway, to get on their peloton bike to do the things that you should be doing. For all intents and purposes, we're all humans, right? Until the squeaky wheel starts squeaking, we don't do anything about it. And so we've got to wrap our arms around that patient as a healthcare system. So it's a systematic approach that we need to take. So to answer your question, where we have gone wrong is we haven't coordinated things together well, and brought the clinicians along with that. It's been, well, let's put some health coaches out there and let's let them do the wellness thing and then just send the diabetics to another special program that's not real well coordinated care.

Speaker B: This, uh, I talk a lot about this, this new drug class, GLP1s, because it's the first drug class that has indications that cross medical specialties. So we're talking about diabetes here as an example, which, uh, is typically handled by an endocrinologist and managed through, uh, the endocrinology office. But they can also be prescribed for. Last year was an indication for obstructive sleep apnea. That's the domain of pulmonology and sleep medicine. And they can also be prescribed for fatty liver disease. Think about hepatology. Think of the example earlier. Where you coming? We think in 2027 there's a strong body of evidence that these GLP1 drugs also, uh, are efficacious for treatment of addiction. And what happens if next year there's, uh, a new indication for treatment of alcoholism? And so we've already talked about obesity. Now you've had diabetes. Then there's obstructive sleep apnea. And in this fragmented world of crossing medical specialties, you have to pull them together. So GLP1s are increasing clinical complexity at the end of the day and highlighting the need for that level of coordination. Then you talk about the access piece, which is workforce shortages are already limiting patient access to treatment and medication. And so if, let's say you can get to an endocrinologist, great. Can that endocrinologist then pull in the necessary sleep medicine specialist, pull in a hepatologist, pull in, uh, uh, a nephrologist for treatment of chronic kidney disease, and then all of that worked together. And so reality is this is the kind of the thing that's evolving point solutions. Originally employers paid for them because traditional healthcare uh, didn't have codes for that if you will. And an employer wanted to say, hey, we're going to pay for this particular piece of diabetes care. We want to see our employees and their dependents well cared for longitudinally and great. And those programs worked. They were completely disconnected of course from the practice of medicine. And uh, in many wellness companies that was an intentional thing by them because thinking that that was too expensive, took on too much risk, whatever. And so even then they were creating fragmentation one portion of care management wellness. But go see your primary care specialist for that, primary care provider for that. So flash forward today you're prescribed if you have type 2 diabetes and you're prescribed and it's warranted, clinically warranted for you to have a glp. Now you better understand obesity medicine. Now you better understand uh, a more fulsome holistic view of an individual's clinical panel profile. And if there are intersections with uh, a dialysis scenario or if there are intersections with even further upstream at a, at a um, stage ah, three ckd scenario, you have to pull all of that together. And this is, this is the thing. So this isn't just cecilia going this way. We see this as an overall foundational, transformative evolution that's happening in the market in terms of how healthcare is being delivered. Finally we used to call it, at one point we called this omnipresent care. So you could go to brick and mortar, you could be virtual, you could be digital. We're finally at the precipice of that actually having all the connective tissue for that to happen. And that's a pretty exciting place to be in terms of took a lot of foundational changes, evolution of policy to get the data interactions, to get to frankly just to digitize ehr, then to make sure the da, the data was flowing from one clinician to another practice, then to have overlays where that can become more readily more real time available on a more uh, real time basis. And then you have to have, how do you scale that clinical workforce which again is a gating factor for everyone. That's the evolution that's happening. And here's new policy and new funding. $50 billion in federal funding to transform rural health and chronic condition management with uh, again the access elevate and rural health transformation programs. And we're all moving in that direction and the incentives are there. And so when you're looking at the framework to support that. We think we found the right mix and how we then plug that in. As health care systems across the country are in their own state of evolution, some falling very far behind and some being far more advanced in, in terms of their relative relativity to each other. It's a, this is again, it's an exciting time and we're just glad to be a part of it.

Speaker A: Absolutely. Thank you, Mark. Wendy, I want to kick it back over to you and then we'll close out with, with Mark here. But there seems to be an instinct in the industry right now to treat AI and technology as the answer to everything. Um, and for a good chunk of it, it is an answer. Where do you think people are over indexing on tech and missing what actually matters in chronic care?

Speaker C: Well, I think there is, there's an important blend of tech and chronic care and we have to get that right. Um, and I think that's what we haven't figured out yet. Where does tech actually help healthcare? Um, and a lot of it actually could make the clinicians much more efficient and let the clinicians work behind the scenes with tech, uh, rather than people out on the wild essentially trying to ask a chatgpt what they should be doing, you know, and that could give back really interesting answers. But we can make clinicians much more efficient with things like AI. And in fact there's some really neat things going on around transcribing and supporting patients that can be done by clinicians so that when you're sitting in a waiting room or on a virtual visit that AI can help do that. I mean think about our teams calls that we do every day. And now we've got our node assistant that can give us back all our notes. I think that tech, uh, will help us with our clinician and physician shortage that we have, which is really cool. Um, and give people much more access to high end care. But it needs to be managed. And I think when you're thinking about healthcare, there are some really neat things going on clinically that can guide people to the right medicines. I think about pharmacogenomics, very cool. And there's stuff happening there around making sure people can get on the right GLP1s, the GLP1s that are right for you. The case that Mark talked about earlier where you have someone on another medication, they're mixing, they're coming together. Tech can help us look at all those medications in whole and say what's the m? Right mix for Wendy Mater. So I think there's a real big opportunity there. When you think about tech, um, I think it's really interesting where it's over indexed today is what I mentioned very much on the consumer side where we're letting people do more maybe guiding than they should. Although I do believe that, you know, you understanding your body and everything is good, but there's also some scary things around that. So I think for us is the mix between the clinician and the clinician having tech support extends out their capability. And I think Mark didn't mention it, but one of the things that we talk about daily is that there's a complete lack of specialty medicine practitioners out there. Uh, you think about endocrinologists and we, we don't. There's not enough, there's healthcare deserts. That's why there's been billions of dollars filtered to fund rural health transformation. And I'm very passionate about it because I'm from the state of Iowa and I'm watching my parents age and the healthcare practitioners there have all retired or left. And how do you get those folks that desperately need it, they're, you know, get aging up there and they need more and more care. More care. Well, they know how to use their technology. They also, they're so they could leverage something like this. They can get access and get support that's needed. How do we, you know, there's not enough RDs or dietitians out there for the road that a therapy like a GLP1 is putting on people to understand what they need to be eating, how they need, what their lifestyle needs to look like in the world. For all the conditions that you have coming out for these GLP1s, which is fascinating. Tech can help with that and, and, but we need to manage and monitor it. So that was a long answer to your question. I, hopefully I made the, the points um, clear on where I think tech makes sense and where it doesn't.

Speaker A: Absolutely. Mark, last question as we wrap up. If Cecilia Health works exactly the way you want it to over the next five years, what changes? Not, not for the company but for the patients, what's actually different about their lives?

Speaker B: You know, what's different about their lives? And actually I may, I may just pile on one point first and then I'll come to the question from, from Wendy's talk track there. You know, when you think about one of the things about AI, first we, you know, Cecilia's done very limited implementations of AI. We presently use it for documentation. We are going to be very circumspect about where that starts to intersect into clinical decisioning. And that's the scary thing because if you look at what's happening in the space just this year, um, and again I'll just focus on obesity medicine. We have the FDA's approved what's called Fonbio now that's Lilly's pill form of a drug. We have a wegovy pill, of course we have the high, high dose version of WeGovy WeGovy, there's Cagrosema. We just saw a readout from Lilly about for next year as is probably the most highly anticipated approval. Reddit Trutide, they're triple agonist Servo Dutide is out there as well. Historically this has been a battle between Novo Nordisk and Lilly and coming soon are other pharmaceutical companies, Zealand and Behringer. Uh, and then you have this emerging pipeline, late 2027 Maritide, there's Viking, uh, Therapeutics, has some trials underway. And then you have these combination scenarios, other drugs in development that are muscle sparing. So as I think a lot of people are starting to realize that when you go onto one of these weight reducing drugs that help uh, reduce weight, you're reducing not just fat mass, you're reducing overall body mass. And if you combine that with uh, what's being tested now, muscle sparing drugs, they could be complementary to a GLP1 therapy, et cetera. The point is that there's an increasing amount of uh, body, what there is a lack of is a body of evidence, real clinical medical evidence, uh, and the quality of evidence to support clinical decisioning. And that's the scary thing. And so when we bring that forward with all this, this new evolution, new indications, new drugs, new complexities, et cetera, what's happening is effectively you have multidimensional shifts in the marketplace, more drugs, broader indications, changing prices for those drugs, lower and higher, complimenting therapies, more specialists involved, more patient value from these drugs because they are efficacious. And so you have innovation kind of starts in a way with how these GLP1s are progressing. And then you have drug indications expanding horizontally across the specialties. And complementary drugs kind of bring a vertical view if you will, to the patient journey. And so this, you have this expanding ecosystem and it's fragmented like we've talked about. Multi specialty platforms like Cecilia will become this organizing layer. And the important thing is to get to your question about five years from now, if you think about this as this rapidly evolving therapeutic landscape emerges. And we realized that, and by the way, it's not just about GFP1 drugs. There are other drug classes coming, like immunosuppressives, that are also straddling multiple medical specialties. This, this delivery, this healthcare system that we run here in the US will look dramatically different five years from now. Yes, some of it will be AI driven. Yes, it will be even more delivery will happen in, in the palm of our hand, uh, through our mobile devices and whatnot. I believe five years from now, this hybrid model where we're coordinated with in either in home or in clinic patient interactions can all happen in a universal and easy to access way. One that's all wrapped around, where no matter where you go digitally or physically, you have the right information at the right time. Not just you as a patient, of course, but also your clinical decisioning team has the right information at the right time. Can we get there in five years? Healthcare in the US Evolution in the US moves very slowly. So five years may be a bit of a pipe dream. Maybe this, uh, will take a little bit longer than that. But what we care most about is patient safety and accessibility at the moment, as we're bringing this layer of evolution forward and to bear, that is what excites us. That's why we're getting up every day and talking to everyone across the healthcare ecosystem, creating partnerships. Whether that's with employers or pharmacy benefit managers or health plans or provider to provider, all these different care settings are starting to emerge and move in that direction. So. Long winded answer, Jared, but, um, we're just scratching the surface of where this is going.

Speaker A: I like it. Not a long one. It ended. I liked it. I really enjoyed our conversation today, Mark, Wendy will have to do this again soon. Please keep me up to date on, on anything, uh, happening that you want us to kind of shout out. Really appreciate all that you're, you're both doing in the space. And, uh, yeah, thank you so much for joining me on the Slice Healthcare podcast here today.

Speaker B: Great, thanks for having us, Jared.

Speaker C: Thanks, Jared.

Speaker B: Appreciate.