Precina Health: A New Approach to Type 2 Diabetes

Show notes

Precina Health: Dr. John Oberg on Rethinking Type 2 Diabetes Care

Tens of millions of Americans live with diabetes. Co-host Dr. John Oberg tells Randy Lorensen why he started Precina Health and how its virtual practice approaches type 2 diabetes differently.

John lays out the size of the problem and its complications, and why many endocrinologists and primary care providers are frustrated with the system. He explains what Precina does differently: more time on the little things, tracking between visits and following up when patients miss a dose.

He explains what A1C measures, shares patient stories and talks about meeting people where they're ready to change. They also cover the psychological side, a patient co-pilot built with AI, why the provider still has to lead, and working inside the existing payment system.

Finally, John is candid about the challenges of building the company, from go-to-market to funding, and what he sees as Precina's superpowers.

Type 2 Diabetes Care, Virtual Follow-Up and AI

What you'll discover:

How big the type 2 diabetes problem is
Why providers and patients get frustrated with standard care
Following up between visits
What A1C measures
Where AI fits, and why the provider still leads
The challenges of building a healthcare company

This episode is for educational purposes only and isn't medical advice.

Host Dr. John Oberg founded Precina Health, the company discussed in this episode.

Timestamps

[00:00] Introduction: John on Precina Health
[01:40] How big is the diabetes problem?
[03:12] The complications of diabetes
[04:45] Why providers get frustrated
[06:17] How Precina is different
[07:50] Technology, and tracking the little things
[09:24] Following up when patients miss a dose
[10:57] When a patient doesn't answer
[12:32] Keeping patients out of the hospital
[14:05] What A1C measures, and a patient story
[15:38] Meeting patients where they're ready to change
[18:43] Being the glue in the system
[20:15] How much of it is psychological?
[21:48] Filling the follow-up gap
[23:21] Making the model financially feasible
[24:56] Building a patient co-pilot with AI
[26:30] Why the provider has to lead
[28:03] Serving Medicaid patients
[29:38] One narrow area of mental health care
[31:10] Working inside the existing payment system
[32:43] Patients juggling 15 medications
[34:15] John's path back to clinical work
[35:50] Challenges along the way
[37:23] Who is Precina's ideal customer?
[38:57] Go-to-market and funding challenges
[40:32] Rethinking what diabetes care looks like
[42:07] The clinicians who work with Precina
[43:40] Helping patients engage in their health journey
[46:51] Precina's superpowers
[48:24] Founders who know the problem firsthand
[49:56] Licensing and growth
[51:30] How to reach out

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About Precina Health

Precina Health is a virtual medical practice focused on type 2 diabetes and chronic disease, founded by Tales of Abundance co-host Dr. John Oberg. This is a hosts-only episode with Randy Lorensen and Dr. John Oberg (Anthony Marino isn't on this one). Host bios are on the host pages linked below.

Find Precina Health:

Website: https://precinahealth.com

Find us online:

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▶️ YouTube channel: https://www.youtube.com/@Tales_of_Abundance
🎧 Spotify: https://podcasters.spotify.com/pod/show/tales-of-abundance/episodes/Ep--4---Precina-Health-e2s45e7

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Related episodes

Meet the hosts: Randy Lorensen · Dr. John Oberg · Anthony Marino

Transcript

A full transcript is below. It was generated automatically from the episode audio, so expect some spelling errors in names and terms.

[00:07] here for another episode today this one is going to be me Dr. John Oberg with my co-host again Randy Lorensen here we are Randy hi good afternoon and uh today we are going to go a little deeper in something on the episode introducing you we mentioned Precina and we said we would dig into it deeper in the future and that is this episode so you ready to get rolling priscina Health yeah let's do it okay great well John let's just start out priscina has a bold Mission um to solve diabetes and chronic disease nothing nothing like easy problems so uh tell tell us a little bit about what you're trying to do and and tell us about that mission yeah Prisa health is a medical practice that does tele medicine and it really was an extension of when my mother-in-law got sick and and had a type 2 diabetic event ended up in the hospital and unnecessarily and so I went back to college got my doctorate and worked with Dr Dustin Williams who's partner medical doctor we created a new set of medical protocols that include medicine mental health it includes evaluating the social determinance of Health psychosocial factors we look at all those things to help patients get their diabetes and other chronic conditions into control we've been really successful with it um so for the listener I mean we all we've all heard of diabetes but how big is this problem I mean is it Millions is it tens of millions is I mean I mean how big is this problem there's about 33 million people in the US that have diabetes that's been diagnosed there's you know we're not sure how many more but maybe up to eight or 10 million more people in the US that have type this is all type two diabetes there's two kinds of diabetes type one and type two type one means that essentially your body is not creating insulin type two means that your body is resisting insulin so still making it but resisting it two very different problems two very similarly named diseases that get treated very very differently in a lot of ways okay so in worldwide how many people ballpark I mean gosh 8% of the world 640 it's going to be I don't know three and a half billion people have chronic disease of some kind and uh you know I'm guessing I have to go back and look at the numbers slight but it's going to be close to a billion people that have diab type diabetes so let's talk about I mean what happens if it's not treated right like my mother had diabetes and when she died we didn't even know she had diabetes she didn't know she had diabetes because she never went to a doctor but when she died part of her when she was in the hospital they did a blood test or whatever and they figured it out so what is what happens when people don't treat it I mean what are the consequences yeah I think it it can do a lot lot of things it can cause organ damage it can lead to other complications and problems and eventually it just what it really leads to is a shorter life right okay and it can lead to a more miserable life like you you know diabetes can lead to amputation it can lead to loss of eyesight just bad stuff fun fun stuff so dying is one problem losing losing Limbs and you know um there's also like uh you know people that have the tingling sensation in their limbs they can't get rid of so lots of lots of problems okay so properly treated properly diagnosed what's the difference I mean what what impact does this have on people yeah I think once it's been diagnosed it still has to be treated and for some people they can actually reverse the disease and not have any more problems with type two diabetes um and there are some people that there's enough damage that's been done that's not reversible it's just controllable okay let's I'd be remiss this podcast is Tales of abundance right why settle for less so how does that apply to somebody with diabetes right I mean what is what is what you're doing at priscina how are you helping create more abundance in their life it's a fair question I think there are a lot of PE a lot of patients we've dealt with that have had type two diabetes for years or sometimes even decades and they they're just frustrated they're frustrated that they are still in uncontrolled chronic disease land and they come to work with us and you know weeks and sometimes you know a few months later they've controlled their disease often times for the first time and they feel like they're getting um a different type of care than they've ever had before because we have a different set of protocols they've ever had before and this is not to knock endocrinologists or primary care physicians who are treating diabetes every single day many times successfully but the truth is that oftentimes endocrinologists and Primary Care Providers are frustrated uh just like patients are that things aren't getting better the American Diabetes Association has has 500 and some recommendations for Physicians on how to treat diabetes you know several hundred of those are about patient self-management and and we've known about these self-management things for a very long time and yet the problem is getting worse and so we want to make the problem better and so now you know Dustin and I have written a series of protocols that use existing medicine existing devices you know everything that's needed already exists so that patients can actually get better and it's good not just for patients with like the best medical care in the world available this is something that can be done in Rural and lowincome populations so what did you call it you called it patient self-management yeah what let's dig into that what's what's the problem what what generally goes wrong there Mo most often you know um and I'm G to I'll hyperbolize a little bit here but most often somebody is told to eat better and and and I think most people know what it means to eat better on exercise but they don't do it and so the doctors told them what to do the patient says they know what to do the doctor might even say do you know what that means the patient will say well yes and they come back three months later and it hasn't been done right that's most people right right so how are you different well we we take a lot more time with patients on the little things and so we take a five phased approach where the first phase is all about assessing exactly where the patient is and that's a big part of the difference is that I created a chronic disease trios treatment planning Tool uh in my doctorate where a physician and sometimes with the help of a mental health clinician sometimes just the physician will look at all of the mental health conditions that I'm sorry all of the medical conditions rather that a patient is you know faced with then they'll look at the medical the mental health conditions uh that may be Rel related to that disease state so someone might have anxiety about their diabetes they might have depression about their diabetes they might have stress about their diabetes and and then we also measure the social determinants of Health that are actionable and then the ones that are not actionable we measure as well in some cases we look at some social some psychosocial factors that help us to understand what the patient can and will do and then we evaluate what's called Readiness for Change and so we look at what the patient's most issues are we look at what they're willing to change and then we help them change the things they're willing to change and we start really small so usually it's about making sure the patients are taking their medicine on step one so phase one take your medicine how how do you how are you doing that yeah we have a we're we're using um all types of artificial intelligence and uh you know all the latest technology but at the end of the day we ask the patients to track when they're taking their medicine and if they don't do it we gently and appropriately find out why okay and how does that differ from the traditional approach well most doctors they tell they give you medicine they tell you to go home and check in in two weeks or four weeks or three months and you're checking in when well the next time they're supposed to take medicine and so if someone doesn't take medicine we will check in with them and say hey what's going on and so you might have heard about things like remote patient monitoring and there are lots of Physicians who are getting paid to handle remote patient monitoring and it's incredibly effective getting people the right doses of what they need when they need it most doctors don't have time to call a patient who hasn't taken their medicine for a day okay we do let me let me try and summarize this because this is there's a lot coming here for me and I think the listeners so in a traditional approach if somebody's supposed to come back in two weeks they give them two weeks of medicine and that's the next time the doctor checks in right could be yeah usually three months but two weeks Could Happen three months better yet okay you if they're supposed to take medicine daily is that normal yeah they what they'll do is they'll put it into their remote patient monitoring system and then we have the time energy and protocols so if someone's not taking their medicine we know how to engage with them in a way that's productive healthy and helpful to the patient so that if they're not taking their medicine we find out why but you're finding out daily the next day after the appointment how is this possible well they put into their application that they did or didn't take it if they didn't we then reach out to them and say hey what's going on let me give you an example we had a patient who was in control for a number of months and all of a sudden out of nowhere their blood sugar spiked for a day and it spiked in a really nasty way so a provider got in touch with them and said hey just checking everything okay and they said I'm in Miami visiting my in-laws I just ate a whole pizza I'll be fine by Monday didn't have to worry about that patient okay now another patient um entered in a blood glucose number um if you're below 70 that's really dangerous backing up diabetes is about high blood sugar but if you have low blood sugar that can be dangerous too especially if you're taking insulin this patient put in their blood sugar was 12 oh now that's pretty bad number like you're probably in the hospital and you know if it's even possible they probably meant to put in 120 or 102 and some button didn't get pushed but they put 12 and I I happened to catch it we're not an emergency system we don't monitor in real time but I happened to catch it it was Friday night I was ending my day it wases about 9:00 at night and I just happened to be looking at something and I called their home phone and they didn't answer and so then I called their cell phone and they didn't answer and then I called Dustin and said hey duson this probably is not a hypoglycemic event it's probably just a mishit button but it is and we don't do anything about it he's like yep you're right so I called their emergency contact no answer I texted their phone no answer so we called 911 we had the the you know the ambulance show up with the fire department and they knocked on the door and they were watching TV they were totally fine they just put the wrong number in fire department called me back and said your patient's fine and then the patient called me and said hey Dr. Oberg really sorry about that like didn't realize you were checking it's like hey normally we don't check this closely but we were concerned that there might have been something really bad going on and they haven't missed they haven't missed an entry since wow it's um I think I speak for everybody listening that that is very different than the experiences that most of us have when we deal with a doctor or deal with you know any kind of health care right I mean well yeah and it's not the doctor's fault like like I went to to get my doctorate and what I did is I I recognized how the system was set up for medicine today and you know at the end of the day broke down the entire patient experience and the entire doctor's experience and rebuilt it from the ground up and then we did it in such a way that it was affordable for the insurance companies so the insurance companies are paying us and saving money by allowing us to run through all of our protocols the way that we do yeah and so you know if you keep a patient out of the hospital a really sick patient out of the hospital a payer might save 50 or $80,000 you know in that one hospital visit so if we keep patients like we kept 83% of our patients out of the hospital for two years wow who were really really sick patients and so like that say the estimate they gave us was that for every dollar spent in a system like this the payer saves net4 so save five spend one save four total it's good math yeah um you know don't have to be that good at math to figure out that's a big win that's it so that's it tell us about some success stories I mean you've given us numbers and given us a couple of examples but and and clearly you you know it's medical confidentiality you can't use names but what but tell us a couple of your biggest success stories got so many interesting ones we had a patient a few weeks ago a couple months ago now that um their wife called in with them and was appropriately talking to our providers with the patient the patient had um early on S dementia and was only eating uh ice cream and CH drinking chocolate milk that was the only way they were taking calories in sounds delicious yeah well not great for blood sugar and so they weren't willing to change their diet so our providers smartly and you know they were trained they said you know can we change the type of ice cream they're eating and in changing the type of ice cream alone dropped their blood sugar 100 points in a week and then there's confidence of the patient at that point to make other changes right and so that's just about how you build trust with a patient right we had a nurse who was diagnosed with typee two diabetes in the hospital emergency room she forced them to take her blood sugar and her A1C which is A1C measures how your blood sugar has been for the last 90 days and seven means you have diabetes hers was 14 which is really really bad and she didn't want to take insulin and we weren't really excited to hear that but we said we'll try we'll work with you and 6 months later her diabetes was fully in control under 7% now remember if you get a drug that reduces A1C by one percentage point in a year there are people that would tell you that's a billion dollar drug and there are gp1s right now that will drop blood sugar by you know 1% every four to eight weeks but we did that without using insulin we helped her drop 1% of A1C per month for six months and changed her life and never had to use insulin that's great yeah wow so obviously you have to have a you know you can lead a horse to water you can't make them drink so you you've got to be able to empower is this empowering to the to your customers your patient I guess patients what is what you want to refer is what they're referred to as yeah or are but well remember we measure Readiness for change right and so if someone's ready to change one thing but not another as long as there's nothing emergent and severe we're going to help them change the thing they're ready to change and when someone is ready to change makes a change sees a result in in very small ways we can then say what's the next thing you're ready to change and we can use techniques like motivational interviewing to help people you know become a touch more motivated but but the reality is the reality is that people are ready to change some things and not other things and so we do a really great job of meeting the patient exactly where they are let me so I want to go back to my my mom my mom didn't have diabetes but and getting her to go to a hospital would have probably had to been at the end of a gun but let's assume she went in and I know what would happen if she did go to part of the reason she didn't want to go is the doctor told her you should quit smoking yeah she didn't want to hear that yeah I'm pretty sure it would have been the same conversation with diabetes so you get somebody like her she's stubborn amazing woman right love my mother was great one of the nicest sweetest people you could ever meet but stubborn yeah she comes in she's got diabetes she doesn't want to change her lifestyle so me I'm going to tell you a real story instead of your mom so I we had a patient that came in did not want to use insulin didn't want to inject insulin they did not want dialysis and uh they were really convinced of that and and they were going to be dead within 60 days if they didn't do those things and so I called the patient and said hey look I I understand from our medical team that you don't want to take insulin now I want to remind the listener I'm I'm a doctor but I'm not a medical doctor I'm a social work doctor so right I'm the mental health guy so I called and said hey I understand from our medical team that you don't want to take insulin and he said that's correct and he was like you know serious about it I was like great uh I just want to let you know I support that he's like oh you're great I said yeah I heard you don't want to have dialysis either he said yeah I don't great I support that too um I wanted to make sure that we got you a good referral for either Pala of care or a good estate attorney he said what's that I said well those those are the things you need when you're going to die because you've got about 60 days to live it's in your medical chart your Physicians shared with you that you're 60 or 90 days from being dead and I just want to make sure that your family has their Affairs in order so I I'm here to ask how can I help he's like whoa whoa whoa wait say that again and I was very non-judgmental about it I was like hey look I support your decisions these are your choices to make now if you think you can choose not to die and choose not those two things that's not a choice you get so not choosing a or b gets you C and he said would it be okay if I put my daughter on the phone so we got the appropriate medical permissions to get his daughter on the phone and I explained what was going on and by the end of the day he had insulin in his house and he was injecting insulin but he was scared he didn't know how to inject insulin didn't know what it meant so we had to take people through the process of like here's how you inject insulin here's how you make it work for you like answer all the questions like I met I talked to a patient just yesterday who no one taught them how to inject insulin when they were prescribed wow so we did that work for them and said here's and again I don't think that's every medical provider or every hospital experience but it happens often enough that people are Jaded by the system more broadly and all we want to do is be the glue every and I do mean every single primary care provider that I've talked to has been supportive of the work we do skeptical sometimes at first until they hear what we're doing but supportive in the end because they know their practice isn't designed to be able to do what we do and we definitely do not displace the work that Primary Care Providers do we're just glue all we're doing is supporting the work they're doing we have a lot of cardiologists who refer patients into us because Cardiology and diabetes patients oftentimes similar patients and so a lot of Cardiology patients get referred to us to help with diabetic issues and um and same thing I think doctors could be skeptical because they don't understand how we fit in because we're such a different medical practice but what we're doing is we're providing a glue between the existing system to help the existing system work I was talking to an insurance company a few weeks ago and I said you know I'm not here to be a care coordinator you have care coordinators I'm here to make sure the patient calls the care coordinator I'm here to make sure the patient knows what questions to ask the care coordinator and the patient learns how to engage in their own care that's what we're trying to do is help the patient get really educated about how they get involved in their own care but only by meeting where they are not by just educating them and then the patient not actually understanding the education and it failing but really meeting them where they are and being patient pun not intended bit appreciated by being patient with them and actually holding their hand through the process how much of this is psychological emotional of their of their Journey their challenges I mean Randy every decision humans make is made emotionally and then it's Justified logically when you get down to it okay um but how do you help people through that let's if I mean is it are most of your patients is this something they're grappling with because it's new or is it more their they've been dealing with it for years or decades or both it's all over the map I think there are people that are resigned to the fact that it can't can't change and prove me wrong there are people that have been frustrated because I one patient 20 years they've been uncontrolled and didn't know how to handle it we have patients that are newly diagnosed we had one patient had just had a limb amputated because they didn't treat their diabetes well enough and they were finally ready to get serious about it so we it's really all over the I talked to someone yesterday again who called and said hey I am committed doing whatever it takes but I just moved from one city to another don't have Medical Care in the new city I'm not sure what to do and and they're personal friend so they knew that I was dealing with this and they said would you be willing to help this morning I had someone who called and said hey I just had a family member who was diagnosed two weeks ago and our doctor's appointment is coming up we don't know what questions to ask so you know people want to do good Physicians definitely want to do good and they're generally good at what they do but there are times that they just don't have the time to follow up in the way we need to when someone's dealing with a comp licated issue yeah a broken arm and diabetes are treated very differently I'm being a little tongue and cheek here but you put a cast on someone's wrist it's not going to come off until you take it off right so the when most people think F or Health Care these days they think oh God it's expensive right and you're talking about exponentially better results let's talk and you mentioned a little bit earlier that you want it saving but I mean what what's the financial impact for customers let's go a little deeper into that yeah I think that so there's two people that are paying the bill there's the payer that pays the bill that's the insurance company and then there's the patient and so if you can keep the patient out of the hospital so they're not having to pay for the hospital visit and you can keep the payer from paying for the hospital visit it may cost a little bit more from Office visits um but and it may cost a little more for the medicine but but that pales in comparison to what One hospital visit can do one Hospital visit from one patient can wipe out the gains for you know eight or 10 patients I don't know the exact number but a big number of people and so you know it's it's that it's that a stitch in time saves nine stitches later yeah so that's what we're trying to help people do now we also make sure that we can see a lot of patients by using technology inside the practice so that it's financially feasible to do what we let's let's let's go deeper there so I know well enough to know that you're doing a lot of work with AI yeah right um what can you tell us about that I mean you know that AI is its own yeah whole on podcast or multiple podcasts of its own but but whether it's AI or other technology like what what is that doing for you as a company sure and more importantly for your patients there's a lot of this stuff that everyone's doing like we're creating content using Ai and we're using AI for chat Bots and we're like all those basic things we're starting to employ that now we're also developing a patient co-pilot where when the patient calls in they have an AI specific to their case that can help them navigate things without hallucinating that's the key without hallucinating about anything on their case that's medically important and uh we're ready to deploy that coming up this year and that'll by the way let me by hallucinating for people that aren't familiar chat GPT or some a lot of the AIS are well knowing for giving you really great answers 80 90% of the time and then 10 or 20% of the time they don't know what they're talking about and it just makes things up but it sounds really credible yes it sounds exactly the same yeah as the 80% that was right so that I think just people don't know that ter that's dangerous in medicine right right well yeah yeah and so we have we have um a a patient co-pilot that we're developing that will doesn't have the ability to hallucinate from a technological perspective we've done some things to make that not possible and so um obviously it'll go through rigorous testing before we put it out with patients but so far we've had great success in testing and and we're pretty excited about that and then you know AIS are being used to scribe and transcribe things for doctors a save time and we're obviously doing that as well uh we're also creating a AIS that can help um just answer non-medical questions for people where it can go into a database and search after hours and then doing things like scheduling like you know we don't require our patients to have an appointment um in the same way that a medical office does every time sometimes an AI can just pop onto the phone with a patient take their information get it into our database and if they need a five minute call the providers put that onto the calendar make sure the provider calls them back and so we're lowering the cost of care in a lot of places so that we can spend time with the patient that's and then some other things that we're doing that are really important I was talking this morning with someone about how most people working in AI fail to code for sentiment analysis appropriately I mean there's just there's science around this that is just being missed let's for listeners H for me sentiment analysis is what yeah so if if I said hey your sentiment on the phone is happy sad um you want to hear more about this often times the patient isn't leading the provider to the right answer the provider has to lead the patient to the right answer and so if an AI if someone says um I I'm not interested in doing that right now because I'm really busy that could be code for I don't feel smart you made me feel stupid um I don't want to deal with this because it's uncomfortable and it has nothing to do with them being busy but if the AI gu tells either the provider or itself to answer the question around being busy it it's not tracking sentiment appropriately okay right yeah it's it's not calculating what could happen if someone feels shame embarrassment fear you know and so we have AIS that are guiding people and guiding itself through that and we're coding that into the AI so that when the AI is not certain what the sentiment is it's like hey here's the thing P being picked up on some IED but I'm not going to give you the wrong sentiment okay great let's look ahead what's the future look I mean where do you see priscina moving and going and what what is that like what is that future yeah I think I think we're going to get into situation where we work directly with the insurance companies and hospitals to identify patients and to lower the cost of care even further um there are things you can do in direct pay contracts where you can um ring out some of the administrative cost as well and I think we can lower the cost even more we're designed to be um cost effective in kind of the Medicaid population where it's you know um harder to serve patients and we're designed to be able to do that really really effectively we think we can lower the cost even further over time and then I think at the end of the day we're going to find these Protocols are going to end up being a different subsp specialty of medicine uh that is a part of internal medicine but different than primary care different than Cardiology or Endocrinology or you know any other sub specialty where you're dealing with complex conditions that require handholding and and we're going to find ways to do that uh that feel great for the patient that get amazing clinical outcomes and are able to be cost-effectively taken to Market so they can be done at scale so we've been talking really about diabetes yeah at scale is this scalable transferable to other areas and other things some I mean to to handle diabetes Well there are some mental health issues that we have to address and we're in discussions right now for there there's a couple of clinical studies that have been done that indicate we might be able to to reduce the cost of the type of mental health care we need to provide by 98% wow 98% reduction in cost and in create more bandwidth for mental health care in the places that we can help with so there is some some scientific papers have been written about this it's really exciting early work I think within six months we'll know a lot more but we think we can red and again this is a very narrow part of mental health care not all of mental health care but in this one narrow area we think we can actually reduce the cost by 98% and increase the bandwidth you know geometrically let's I want to dig a little bit more I want to go kind of back to where we started about the the journey this is a radically different approach at least my perception of Healthcare in America yeah like let you can talk more about like like how did you get there like what I I know it it but but what what allowed you to approach this from such a radically different approach right because if everybody keeps doing things the same way you're going to keep getting the same results which is really just led to excuse me Healthcare going up and up and up yeah uh you know I've been involved in healthcare for a long time and I I was the company that I started back in 2014 was a healthcare payer so we're really familiar with the administrative cost of healthcare and how you have to ring them out on the payer side but I was convinced there was things that be done on the provider side as well and so when I went back to get my doctorate one of the things as a part of my program that I was encouraged to use was called design thinking and design thinking um was about really starting from the beginning and doing I mean for me hundreds of stakeholder interviews and nothing was there was no sacred cow it was like we were willing to break down the entire practice of medicine and build it back up the only thing that I required when I built it back up was that it work inside the existing system from a payment perspective so that you weren't trying to change both the practice protocols and the payment protocols at the same time I felt like that would be a bridge too far for for people to swallow and I've talked to a lot of chief medical officers at insurance companies who thought that was the right approach and so we said okay if the boundary lines are you have to use the existing economic system but you have to radically change the system to make it cost effective and a number one clinically effective and then a good experience for patients what does that look like and many failed attempts right so we went through and designed them something and then went out and did interviews and we had experts show us like hey that's not going to work and here's and that's not going to work and here's why and we kept do it over and over and over again and um you know design thinking is not something that was a part of USC's program like that it came out of Stanford's design school as best I know I used a book that was written by professors at Columbia University as kind of my template for design thinking but it's about rapid iteration it it's fail fail forward fail fast we just couldn't do it inside of a clinic because you a clinic needs to be safe right and so the way we did it was we proposed these things to experts proposed to experts people who have you know Decades of experience and then we talk to patients you know hey does what does this do for you what's the big problem does this solve your problem treatment burden was one of the you know far bigger problems than I ever anticipated I talked to patients who were taking 15 medications across five time windows in a day and they didn't have time to go see more medical appointments didn't they had a hard time getting into the pharmacy to get their medicine and so we we realized there was all these little problems along the way that that we had to intervene with if we were going to do solve the problems that we said we were going to solve it occurs to me that like you being able to to disrupt this a big part of it is because while you're a doctor you cut your teeth and your background was more from outside the industry right and coming in I mean you want to talk to that like like the advantage of not cutting your teeth or growing up in that industrys people it's bifurcated right I mean my I joke my first job in healthcare was 8 years old I was filing charts for my mom's medical office because I was homesick from school one day and she wanted me working instead of homesick from school so I was filing charts in her office and you know they orthop surgeon's office by the time I was 12 I joked that I was like you know uh developing X-rays and like in film um hippo wouldn't have that today you know OSHA wouldn't have that today but but my grandfather was a surgeon my mom ran ran a medical practice uh you know I was I was in an HIV Lab at USC when I was 19 uh so so I've been around Healthcare and when I was doing consulting you know in the Consulting part of my career I was Consulting for you know different types of healthare practices on the business side and I still consult for healthcare practices on the business side but I wasn't involved clinically right and so when I got involved clinically first I had to find clinicians who were willing to go along for the ride with me you know Dustin Williams has been an amazing part partner and collaborator um and you know we've got advisers a ton of advisers on our company medical doctors you know um healthc care clinicians like lots and lots of really smart people scientists who deal with sensors and I mean all the people you need to to say hey look we we've tried that before it didn't work we've tried that before it didn't work we've tried that before I mean our um I've got one adviser who's on our board who's you know been the CFO of you know healthcare companies for four decades 26 different sub Specialties I wanted that kind of experience sharing with me like how does it work and how does it fail how does it work and how does it fail and so again hundreds and hundreds and hundreds of interviews to figure out like okay what about this and then what about this and then what about this and then we put it together and we've had you know almost 300 patients go through our system now we're seeing similar results to our pilot study we were just approved uh by an Institutional review board to do a scientific retrospective on the work we've been doing for the next you know 300 patients so we'll start writing academic papers about that in in a case study methodology and then we'll start doing more clinical research I hope in the future to show that these protocols do actually create real Health Care outcomes with real economic value to people great let's talk about challenges so let's start with along the way I mean it hasn't you know it's never easy right especially doing I mean this this is thinking big and and something of this scale there's got to be challenges I mean what are tell us some of the challenges or bigger or more interesting challenges have happened along the way go to Market's always the toughest like recruiting patients and letting people know you have this new way of doing things is always the hardest thing to do and so we're we just need more patience we've got you know a billion people in the world who have this problem and people don't know that we're doing it and part of that's my fault you I tell people I'm a horrible self-promoter um I just need to get out there and tell the story more often which is you know I'm appreciate you let me tell the story today I need to tell the story on a 100 podcasts or a thousand podcasts or you know and let people know that we're doing this and then we need to find Partners who can you know payers who want to who are Innovative who want to make the system better not just for the patient but for the physician for the provider for the for the payer like it I truly wanted a win-win where all of the stakeholders win like we don't take the place of a primary care provider we don't take the place of a specialist we don't take the place of a diabetic educator we don't take the place of a dietitian we don't take the place go on on and on we we're not a care coordinator we're not a navigator we're just the glue between all those things to solve the problem that all the patients said they had with all those providers not because any one of those providers was doing something wrong there just isn't glue in the system so to take that and dig down a step who is your ideal customer who is your avatar yeah we have a couple right so on the payer side we want payers who are Innovative who have patients with diabetes which is every payer and who um you know they they want to see clinical gain and and they're willing to take the economic gain along with it so I think that's most payers and and we need to start with payers who are willing to start with a small practice like we you know we can't take on a 100,000 patients tomorrow but we could take on 5,000 and so that's who we're talking to today so so is in terms of like the a client that's our perfect client in terms of a patient you know our perfect patient is someone who's really struggled with diabetes um you have diabetes if your A1C is seven if you're above nine and a half you're really you need some help and so I'd prefer the patients at nine and a half and above than nine and a half below because there's more opportunity for us to help them quickly can we help patients that have seven seven and a half a1c's yes we have yes we will we'll continue to do that but our heart is for the people that are low access to care lower income really bad problems that's where we really have focused our time energy and attention is the people that other Mark other people say that Market's too hard I've said we're going to address that market headon and we can do it what taking that a step further what challenges do do you foresee in the future yeah I mean I think look like many new companies we have a go to market challenge that we're trying to get the word out there from a marketing perspective we've got a funding Challenge and that every company who's young has more opportunities than they have money um you know i' I've put a lot of money into this personally and I say a lot I mean a significant portion of my net worth and uh and then you know we have technology challenges in that we want to be really Innovative you know we believe we can lower the cost of Mental Health Care dramatically as I mentioned um we think that our protocols have similar enough work we're doing some work with hypertension and cardiovascular disease and we're seeing similar types of clinical outcomes with hypertension we think that'll be help truthful truthful we think that'll be the same as um uh congestive heart failure and Pulmonary diseases like COPD and Asthma and then we think we can take these protocols and leverage them in other parts of medicine where we'll give people the science that we've learned and said here's how we improve medicine in other places the problem is that what we're doing isn't sexy like we're doing the roll up your sleeves and put your hands into the mud all the way up to the elbows type of work uh the providers that work in our offices are getting trained weekly in continuing education not monthly not annually but they they have continu education every single week they have to go and it's stuff they didn't learn in school you're blocking and tackling that's it it's the fundamentals and you won't be shocked to hear this it's the fundamentals of how that professional relationship can be better and more effective and performative if performative is actually a word is there anything I I get the feeling if somebody has diabetes traditionally they're kind of on their own they might know other people with diabetes is there anything about a community there that I think yeah I think there's a lot of diabetes communities and I think that there's um you know we we hope to engage in those diabetes communities and to have diabetes communities of our own both and yeah and I'm I'm really excited about the diabetes communities are out there I think that um like any Community it's there's some really great information out there but there's also some noise and so I hope that as we engage in that Community we can be a uh a Community member that cuts down the noise and really crystallizes the thinking and we and we can help providers give better language for the patients whether they're providers of PR or not we hope that we can provide a better communication path because there are people other than preso who are helping patients control diabetes we're not the only ones doing it we're just the only ones doing it at the level of Effectiveness that I've seen and and I had to study that you know okay um so thinking about what you've done and and you're still a fairly young company right yeah very young yeah what's been the most rewarding part of it so far I mean talking to the patients when when the patients are thankful that's got to be like number one on my list like one a one B is working with the providers we work for we have some um some advanced practice um like Physicians assistants Physicians Associates and nurse practitioners that work with us and one of them shared with me they said you know I used to work with a medical practice that every few months we'd have one of these success stories across the whole practice we'd all talk about it and celebrate it and now I have success stories like that twice a week myself love it and so we're we're reducing Bur out and uh and and we're giving a really high level of satisfaction um to our providers who who are seeing the clinical outcomes they they went to school to be able to see they love that and so I think so onea the patient conversations and one B the provider conversations like if I could spend all my time talking to patients and providers every day that would be Nirvana wow yeah it's somebody that is they've got diabetes and they just feel overwhelmed yeah what what advice what would you say to that person uh first of all you're not alone like I think it's really important to understand that you're not alone and then um if you're not sure what to do reach out like like come talk to us I'll talk to you you know I'll I'll let you know how to engage with your Healthcare Providers I've done it three times this week for people that aren't patients of ours where they just like hey I think I've got it under control but what you know how do I do this next thing and so we're happy to help like it doesn't have to be a patient for us like so um and then we're going to start putting out a lot of priscina content for people to help them uh take more agency in the journey the healthcare Journey so they can actually be more engaged in in a knowledgeable way but it's going to require it's going to require more for the patient and that's what we're really going to do with our content we're going to make it more for the patient like I just learned something yesterday that I'm embarrassed to tell you I took me this long to learn about you know disposing of needles uh in a medical practice that you know and and when I learned it I was like wow I never knew that part of it and you know the nurse and the doctor kind of laughed at me like well everyone knows it it's like no no every nurse and every doctor know that but we're going to write like a little half page paper on that for patients now and say hey here's something I learned and you know in real candid terms like here's here's what I didn't know and here's what I know now and you know I and I was diagnosed with diabetes along the way Randy that's I think that's what you know embarrassingly enough I was halfway through this process where we are today you know done with my doctorate and my A1C came back at seven and I know this stuff I'm teaching it to people and I was like man I'm not doing it though and so I started doing it and I lost 60 pounds my a1c's down to five like I just decided I was going to be the best patient in the practice A1C but by the way is what that's that's hemoglobin A1c is the measurement of your average blood sugar over the last 90 days and you want to be below perfect R below six and a half seven is you know you have diabetes and uh but yeah so I mean at five you're like I was I'm my doctors are ecstatic my my I have a primary care physician who's like you're you're my favorite patient ever like this has been great for you I like well I do teach this stuff like if anybody can do it it should be me but I wasn't right like even though I knew all like knowing isn't enough I had to actually go do it and that meant engaging my primary care provider asking Dustin for help being being humble with my team like hey I'm also impacted and having a community around me instead of being holier than now about it I think that's really great for people to hear right I mean you teach it and still struggle with it so yeah they yeah just so back to the part people are not alone there's help there let's take that person overwhelmed they come they work with priscina they get help what does that look what does their future look like how does their life improve phase one is 30 days that's where we go through the entire evaluation process and we start people making small changes phase two takes a few months that's where we get the disease into control phase three we stabilize all the medicines phase four we engage in lifestyle and and diet and how they're going to actually start to come down off their medicines if possible we've had a lot of people whove been able to come off of the medicine which is a hug huge win for them obviously and so phase four is all about downti trting and getting people off of medicine and then phase five is stabilizing those behaviors they can have a long life without going back and they can have that long you know lifelong habits that keep them in control and so that's that's the five-phase approach that we take so what um what do you think are your superpowers or maybe a better question is what is Cena's superpowers if we are going to sum it up like put kind of put a bow on WE we've we've talked about a lot of stuff if you to sum it up for somebody listening yeah what are the superpowers of this company and this Mi and your mission and yeah the hard the hard part about PR is it's 100 little things right but if I had to like put a thread through all hundred of those things I think we're exceptional at meeting people where they are we're great at the back end making sure that it works inside the system the finance the AI the technology the we're good at all that but meeting a patient right where they are and then taking them to that one next step I think that's the thing that makes us really different and not that most doctors don't want to or know how to or do that for a moment they're just their practices aren't set up to be able to do that for a patient every day okay and what's the best piece of advice that you've received like that has helped you on this journey like what's what's a what's a piece of advice or wisdom that's really just helped that's a tough question you know there was a and I don't remember the I wish I could remember which research paper was to cite this for you but I remember reading research that um while we celebrate as a society the Michael Dells and the and the Steve Jobs and the Bill Gates of the world who started their company at 19 and were really successful as entrepreneurs the vast majority of successful entrepreneurs are generally mid-50s mid-40s they've been in an industry for 20 years they've seen the problems firsthand they know all of the ins ounce of it and and that's who is successful in those those types of entrepreneurial Journeys and I think that this this pren is an amalgamation of things that have been going on in my life since I was eight years old filing charts and uh a call on my life you know we talked about faith at one point in one of our conversations not this this uh episode but you know this has been a a whole lot of layers that have been put together to kind of address this problem and it creates an opportunity for really great professional relationships to be formed to help people deal with an Insidious disease that is quietly killing people in a way that is um not fair and and reversible and now I think it's time we end type two diabetes globally I think we can be done with it well maybe the most important question I have is people that need help like what should they do where should they go whether whether it's a provider it's a client a potential client somebody struggling with diabetes yeah um I don't know investors I mean anybody that wants to help what what help do you need and how can like yeah like how how do we help help more people yeah I think number one we want to recruit more patients to join to join the fight to let us join the fight with them and so right now um we're licensed in three states we'll be licensed in many more States very quickly there's a medical license compact that allows you to get licensed in many states very very fast but Texas California Oregon today you know and we have a lot more States coming online very so by the time a listeners listening to this so so if I'm in Texas Oregon California I have diabetes and I want help what do I do pr.com p re c i n a pen.com fill out fill out a contact form and you'll be shocked at how fast someone gets back to you to hear about what we're doing great um for people that um are interested in investing with what we do you can reach out to me I'm available on LinkedIn I'm available at pra.com I'm very easy to find online um happy to talk to investors about the work that we're doing and then if you're interested in talking about healthc care or Ai and you want to engage in our team about what we're doing to use AI in healthcare more effectively or just technology I'd encourage you again to reach out to me and we'll we'll have conversations about what we can do to help one another um but we're really serious about changing changing the narrative in healthare and I don't want to again I think payers are doing a lot of things right and sure certainly there's things they want to improve I think doctors same thing doing a lot of things right but there's things they want to improve hospitals doing a lot of things right but there's things they want to impr everyone has great intentions that I talk to we're just finding a way to make those things a reality and and if someone's curious about how to do that in their organization and they say you know pristin is not for me but I want to know how I can do that in my organization reach out and I'll tell you how we get it done in other organizations that we help great […] but look I mean I I I love this Mission I love this journey right I mean and it's just it it's a need in the world and like I think you said it well it's not necessarily sex but it's the blocking and tackling that wins the game so time to end two type two diabetes we're done with this it's uh let's move on I love that I think that's a great way to end it so John thank you so much for your time and sharing this really with the world thanks Randy thank you