Clayton Lewis: "Personalized Wellness Era" | Talks at Google

Clayton Lewis: "Personalized Wellness Era" | Talks at Google

I'm happy to introduce Clayton Lewis who is the CEO of our evil and an evil was a start-up of the year I hope that you read the description he is an Ironman triathlete accomplished executive person that's very patient about wellness health has like a really kinda rich career in this in in this space over the last couple decades I believe so today we're gonna talk about what his company is doing what his personal motivation behind the wellness is what are the latest discoveries in the area what are the tools in the data that his company is generating and how is that influencing lives of his customers of friends family community and how it can influence the world in their future so it starts with you know like give a short you know before the introspection of of your motivation or your successes so far your failures and what can go from there so for whatever reason my whole life I have been really passionate around health and wellness and so I was raised in small towns in Wyoming and Idaho and my sister shares a story that when she was six years old everyone had a piece of birthday cake and then all sudden boom the birthday cake was gone and I threw it away I'm like okay you've had your piece of sugar and not that you need to be this crazy or possessed which I'm not but it's interesting to think about sort of what brings passion to each of you and what's most interesting and so my very first business when I was in college which was back in 1977 in Eastern Washington was I opened a health bar and so way before people were thinking about supplements and juicing etcetera I was just drawn to that then for about a decade I worked in politics and so I was one of the youngest chief of staff's in Congress and worked for congresswoman who is the only microbiologist in Congress this was sort of the theme weaves through that I did five startups and took two of them public and so was fortunate partnered with really extraordinary entrepreneur and then help them scale their businesses very quickly then the I went and did a start-up and health and wellness and it was backed by Mavs Ron which is a consumer only venture capital firm founded by Howard Schultz so then Howard and Dan Levitan asked me to join as a venture capitalist and so for eight years I looked at health and wellness and I walked away thinking okay this is a very tattered category and I think the wellness categories failed for three reasons so the first reason is people on the whole don't wake up and think today I want to be healthy you know chocolate cake risk of diabetes tends to be a pretty clear choice eat that cake you know the second what's interesting and especially you know this in your world data actually paralyzes people and so it's so interesting because consumers are spending millions of dollars you know how many people do you know have a Fitbit they're trying to take 10,000 steps and they have absolutely no idea where they're going because the data is not linked to something they care about and then finally this may be heresy but you know a lot of young brilliant entrepreneurs would come in and say oh it's all about the app or the shiny device and we believe passionately a terrible you actually need a person in the relationship so there's a venture capitalist we have run target individuals we wanted back and so a gentleman who's our co-founder dr. Lee hood was at the top of my list and the reason is Lee is one of the first scientists that mapped the human genome he's considered the father of systems biology if you're a scientist it's an extraordinary honor to be invited to join one of the National Academies of science leads one of 15 people in all three but then we're in my venture capital hat Lease founded or co-founded 15 companies that today are valued at roughly 200 billion so he's always launched companies into industries and so I'd been courting Lee for about four years and he said platon let's go have dinner and I'm thinking game on I get to back Lee hood and he said okay science and data is to a point where we can look at individuals as a system look at their genomics look at blood look at their gut microbiome look at their saliva and by taking this holistic view of individuals we can actually help them optimize her wellness and more importantly avoid transitions to disease in both the short term and for decades to come and so he's sharing this vision with me and he said we're gonna change the world we're gonna launch a brand new industry which we're calling scientific wellness and it's gonna be the biggest company of my career and he's the founder of am gem and he points to me and says you're gonna be the CEO and so here I am okay by the way you know I put full disclaimer and you know like one of the Alpha customers so far available whenever the service was announced I talked to my wife okay I wanna try this my background was also in you know bioinformatics so I was really kind of thrilled that you guys kind of started that and how the company is growing and providing kind of more features and users and so forth right so in that vein can you explain more with the changes that you're facing in the field can I put stripping a new start up you know it from Ground Zero growing operation you know can you share a little bit more details about that so when Lee came with this idea that was all about the data cuz of course Lisa scientists so he would think it was all about the data and I shared sort of my view of what I learned in the in the wellness category him and in addition to my work I've also been on the Harborview Medical Center board for 14 years so we're a trauma one Hospital for 23% of land mass in the United States and we're also at the public hospital so we do you know about a hundred million dollars of charity care we treat everyone exactly the same that the individuals that work at Harborview are extraordinary I'm also on the board at the University of Washington Medical Center and so and when I first joined sort of doing volunteer work and governance work in health care you know I thought okay everyone should have access to health care but of course as you dive in you learn it's not really health care it's ill care because on the whole in America an average individual spends 17 minutes over the course of a year at their primary care physicians 17 minutes so in that 17 minutes they're basically going to make sure you don't have any symptoms and I have such respect for health I mean clearly I'm on two boards but those individuals are trained to treat problems they're not treated they're not designed or trained to optimize your current wellness so when Lee came with this idea I had been following another company in town where I was trying to recruit out the CEO to start another business called free and clear and what I loved about free and clear is they had the most efficacious smoking cessation behavior change weight-loss program in the country and it was all about behavior change and they had scaled to where they were onboarding they've gone from 40,000 individuals a year to 400,000 and about a year before they've been sold to a lehre so I rated the company I got there chief translational science officer their head of coaching their chief business officer even their Director of Finance to come help us build this company and we decided to do a test in 2014 and so basically Lee and I recruited 108 of our friends and we did what's called an institutional review board approved study and it looked a lot of like this room you know people came everyone thought they were healthy all actively engaged in the healthcare system and so we created this dance dynamic data cloud so first we did whole genome sequencing and we try to be really clear genes are not your destiny but it gives us some really interesting insights into predispositions so that's quadrant one quadrant two we looked at was clinical labs and so when you get a typical physical they're gonna look at about 30 different analytes we look at north of 90 because it's these analytes that are a reflection of your life choices to date then we take us alive the measurement and we look at four different day part measurements of saliva because that gives us insights into hormones cortisol levels are you really managing this stress look at gut microbiome it's a nascent field but in the context of a system it's pretty fascinating and so and then of course assign a coach and the coaches are registered dietitians so these hundred nate people as they went through this journey and I'll share my story I was one of them turned out ninety percent of them had meaningful nutritional deficiencies meaning nutritional deficiencies impacting the health journey the wrong 70% over time we're moving towards chronic disease states and it doesn't mean on Wednesday you're gonna get diabetes but look at heart health dimensions diabetes stress markers optimal nutrition and 3% we're living with diseases so I'll share some stories so at that point I'm a venture capitalist and medicine in health and wellness I was president of the board of Harvey Medical Center in the middle of training for Ironman Canada and I had done this experiment about the past four months where I got an a paleo diet because I thought the Paleo triathletes seem to be faster and and I'll have brilliant blood markers with this Paleo diet and I embraced it wholeheartedly and so I sort of said to leave my cup handle yeah I'm gonna be the healthiest person in this study and so my data comes back and the first thing my coach says is you're pre-diabetic and I'm like oh there's been a data switch like that cannot and so she helps me understand I had a genetic variance where I actually cannot process a paleo diet I need rich dense complex carbohydrates in every single meal to normalize my blood sugar levels so how counterintuitive is that is a paleo may be pre-diabetic with very high inflammation markers so what she then help me understand is that 108 people I had the highest mercury level of anyone in the study to the point where in the future I like to say it was going to impact my neurological functions and so think about it I get it physical every year you know I'm actively engaged no one's ever told me this so once again the value of the 'coach registered dietitian backed up by a clinical team backed up by a physician so she says you have variants at about 20% of the population have where you do not process toxins as well some people so that might be the reason for your buildup do you eat a lot of tuna sushi and let know I'm a salmon guy and so further exploration well how old were you I was 56 at the time do you have a lot of old fillings and for about a decade my dentist has said you know you should get these films replaced and like yeah next year next year and so these old amalgam fillings had been leeching mercury into my body because they have these variants right don't process toxins as well some people they built up and so all the sudden have got insights and reason to get these feelings replaced had a mole replaced it took my body about a year to normalize my mercury levels on the more extreme side and one of the first things the coach did is it says why you're here you know what's being healthy look like what do you want to be doing at five years what do you want to be doing in ten years so this individual shared he so I passionate about hiking they live to hike and he was starting to have cartilage issues in his ankle and his physician sort of like early sixties there there that stuff happens and so we do the genetic profile and he's got a predisposition for hemochromatosis which is the body doesn't process iron and so then we on our standard panel look at ferritin levels which is an indication of iron highly elevated now we're a wellness company so we don't treat we don't diagnose we don't prescribe so we say take this data and go have a conversation with your physician we actually got a thank you note from the physician because he said I didn't have access to genetic information and so I wouldn't have thought to look at the ferritin levels and the great news is that when you catch hemochromatosis early you just have to donate blood on a regular basis and that normalizes the iron level so we did the study of 108 people and dramatically improved I mean all of them said you know you materially improved my wellness and so we decided to launch a startup and so we launched Arabelle two years ago last July and as a start-up initially we raised 36 million dollars have raised about another 15 s have raised about 50 million today and like every good scarred up lots of scar tissue and lots of successes but what we're most passionate about is worried about 4,000 individuals now have gone through the flagship program and every individual that signs up they get an email from me with my cell phone number my email address and so I talk to lots and lots of people who go through the program and just so passionate because of the impact that these individuals on this journey of what they're doing to change their lives settings for the question yeah yeah yeah great so let's spin a little bit into the into this kind of very nascent field of the industry for example I did like the 23andme test it's been owing so I guess to answer immigrants before but with a different kind of niche providing me more of introspection of what are your genetic predisposition for different diseases was your ancestry and everything else and I think that they did it amazingly well at great interface great and then somewhere in the middle they didn't accelerate the trend to get from that point to a folk another combination system right so based on the data based on you knowing collecting and different signals like your blood saliva tests and and basically knowing I believe that you entered into that space very efficiently but I seem like other organist and ups kind of getting into the area so how do you feel that whole space even it's more nascent now here a couple of players how do you see that whole space going so as an investor I met with an the founder 23andme and very thankful for what she's done because she spent hundreds of millions of dollars creating a brand and it's interesting because both 23andme and ancestry what they've done is they've raised consumer awareness to think okay genetics I can learn my ancestry and that's kind of fun you know and for $99 what the heck it's a transactional purchase and so from a general consumer awareness it's sort of either people thinking I needed about my genetics for a disease State or let's find out where I'm from and I think ants and a good job there what's interesting obviously is that the data she has is from a snip panel it's a relatively limited amount of genetic information and it's one data set one moment in time and so when we looked at that I've yet to meet a person who went through 23andme and said oh it changed my life I'm much healthier because of what I learned and so what we've been very focused on is we're even really clear with our members genes are not your destiny and we actually don't even coach the genetic variants we're coaching to the clinical analytes but what we're doing is looking at the variants to help us understand why we might be seeing what we see in the blood data and so first distinction is where a system genetics data got microbiome saliva trying to look at you as a system because people have signals from different parts second we refresh it people's blood every six months because it's the change in the analytes the change in the data are are we moving you from red to green and I'm in year three of the program and I'm now just turning my attention to my cortisol level because I had to get the diabetes and check then I had to get the cortisol work in check and so and what's important we organized these five health dimensions so you know diabetes risk heart health the inflammation optimal nutrition for each of you in the room they would be stacked ranked based on what we see going on in your blood then within each health dimension the analytes would be stacked ranked to what you need to work on what you need to watch and what is optimal and what's great about that is it's dynamic but then let's say you got a heart health we're gonna show you genetic variants that impact some of the lifestyle decisions you need to make so for example we look at LDL and it's a geek out a little bit here so our scientists have curated over a thousand genetic variants related to LDL because what's interesting is a single genetic variant is rare and of itself and has limited impact but you put a thousand genetic variants together we create algorithms we look at the weighting some are positive some are negative and now we've done studies and so it's been fascinating that for LDL the bad cholesterol we put roughly at that point we had three thousand members into five quintiles and came up with a genetic predisposition for having high LDL and everyone mapped beautifully to their genetic predisposition unless they were on a statin so then how do we use that information to coach so let's say you come in and you have a brilliant genetic predisposition and you have really high LDL the coach knows we're going to be able to give some interesting lifestyle recommendations that are actually going to impact that we're on the flip side I genetically am screwed from an LTL perspective I eat right I exercise I'm in category five and genetically that's where I'm gonna be and so my coach says make sure you're talking to your physician about a calcium scan of your heart maybe Carteret artery to sort of see are you building up so that's where the genetics once again can bring to life to sort of give visions of when we're looking at all these analytes what should we be looking for that answer the question yeah so hearing you know like the build-up a little we don't know what you said and when I kind of venture into the baseline all the studies right basically what's a baseline for health for every individual on many of the tests that that you're providing right present the blood markers they have like a categories for you know decades that okay you know if you're in this category that everything's fine i but that very own individual individual basis right and then find green you you go more into the depth of every scale then you can have like a more kind of fine grayed out comparing individual based on the differences into the genome and and everything else right and in many of the advice is basically old advice in the classical kind of health industry today and relies on those standardized measurements that they're saying but for you for everybody right so I'm guys thinking more about that field going more in-depth so right now the message is primary optimize wellness that what's interesting is to look at genetic predisposition both for wellness and for disease and so we're now launching some clinical trials so give you one example our co-founder dr. Lee hood believes that Alzheimer's is probably actually eight to ten different diseases and so if you go in and understand someone's genetic predisposition well it could be then the ohmic that's triggered the disease say it's a protein or a metabolite or a clinical lab or even something in your gut if you interested the genetic predisposition for different individuals then you'd actually look at different omics to say is the disease triggered and if it's triggered what would be the right could be sent in some cases pharmaceutical solution what would be the right lifestyle recommendation to actually slow down or reverse the transition into the disease state so in this first one we're launching with Alzheimer's we're taking 200 individuals have early cognitive decline so and first thing we're doing is going in and creating these dense dynamic data clouds to understand what's unique about them genetically then we were on if you're not in science you may not know this publication called Nature Biotechnology that it's considered if not the first the second most premier scientific journal in the world it's a peer-reviewed journal so we submitted a paper on the first hundred and eight individuals and what our scientist did is that we came up with a correlation network where we looked at someone's genetic predisposition and then we found what were the signals to that genetic predisposition to metabolites proteomics clinical labs gut microbiome and for this paper the scientists just pulled out 32 different signals of the 32 signals that we identified the correlations turned out – were already drugs in market once a drug and clinical trial and the other 29 there was no paper or research we could find now what's important about that is that many of you in this room right now may have a disease that started in your body and you may not have symptoms for a year and in some cases for a decade but when you finally have symptoms that's when you're going to show up or present yourself to the healthcare system well imagine if we understood your genetic predisposition and we understood which omec is unique to you that we should be tracking if there's something that's relatively high risk it's starting to do that at a very low cost so here's an example an individual been in our program for two years very sadly shared with her coach that she'd been diagnosed with stage 4 pancreatic cancer in says stage 4 pancreatic cancer tends to be failed because it's stage 4 because it's asymptomatic as it's going through its whole journey so we bio Bank blood from every single blood draw which we do every six months so with the permission of the individual we went back and we analyzed the prior four blood draws over two years and did a really extensive proteomic panel turns out there's a protein that was completely out of range from the other 3,000 individuals for this individual completely on range and she was the only outlier as we did research on that protein it turns out it's linked to the function of the pancreas so imagine if we interested in genetic predisposition for pancreatic cancer not hard to do then think if we actually can identify what is the omec you know a protein metabolite that says that disease has triggered started its journey and knew to intercept it long before real damage is done another example individual comes in she has a protein that in our first interaction with her is materially out of range so we work with independent third-party physician he called her said you need to go see your physician she's like well I had the flu during the blood draw he said okay well that could have been it six months later is still out of range so once again physician referral says she's gonna do it it doesn't do it six months later now we're 18 months in and we're like our chief translational science officer Calder's that we don't know this is serious but you really want to go have a conversation turns out she had leukemia and so once again it's interesting now as our company is getting older to look at these transitions from wellness to disease and of course the big idea here is to avoid the transition to diseases because of where the science is and so that's part of what we're doing another example would be because we look at gut microbiome which is so nascent I mean it's very nice and what's interesting is that there's companies launching you know that are only looking at the gut and we have a number of individuals that are experts in this so as we look at the bacteria in someone's got there's certain types of bacteria that if you're over indexed aunty Mao if you eat red meat in both the short term in the long term you're gonna do meaningful cardiovascular damage to your system so we now give everyone a TMAO score to say your TMO is highly elevated you on the whole one-oh avoid red meat or we need to figure out how to drive better diversity in your gut if you're passionate about eating red meat so there's a couple few examples wow that's impressive so this is what I'm thinking right how do you see the future going into this field item like one we here at Google oh you know that we live from the days on the real-time data right that keeps kind of coming 100 percent of the time what process that and we build systems to process that's right here in like in the film you know it seems very nascent right here taking the blood was for six months right the microgram tears and what's prettier than Salva test one spurious one all right and then the DNA probably simply it's fixed because it's your cold and you don't need to repeat that but then you knowing how do you see you see can any kind of future investments going into the field to make this kind of more can i real-time now it's hard right it's hard to kind of inject the chip and get your blood test you know a Wi-Fi real-time transmitted so every day can track that or get your microbiome analyzed every day but they see that the future going there so three things one when we did our initial study two and a half years ago we were spending ten thousand dollars per individual on the assays because we were both we both the number of assays and the frequency of the assays we didn't know where the signal was going to be coming from so for two years we burned through a lot of venture capital where we were doing all of this data we've now reduced the asset cost down to roughly twelve hundred dollars and we're giving all of the exact same information and so one of the first things to be thinking about is of course you've all heard about Moore's law related to genetics yeah I know when Lee did the first micro of first whole genome sequence God knows how much what it was we were spending roughly 1400 on whole genome sequence and now we're doing a snip now because we're getting the same data you know so in two years a company went from spending roughly fifteen hundred to 175 on genetics same data second thing that we did is that as we now with these first three thousand individuals every six months we were doing the full panel of omics well now we know if certain omics are in the green they're not going to move into the yellow or red within six months so we do what it's called reflexive testing at a six month mark full testing so what we've got to do is get the cost down you know for the first offering of roughly seventy days for all the blood and all the genetics right now it's 999 dollars a lot of people that's too much money and our goal is to democratize this and so you know it was so sad to follow what happened at their nose because if microfluidics what it worked that would have been a brilliant way to make it a much easier and be much more affordable but we do believe technology cost in the assay cost will be coming down so that's job one job too health care is basically a giant ocean liner and it's very slow to change but what's been interesting in my 14 years as a trustee is that when I first joined the board you know our KPIs rahl around billing codes where we had to bill for the pill a device the hour we're now in volume based pricing so if you show up and you have an event and you're coded for that event I show up and have the same event and I'm coded for that same event you stay three days I stay two weeks we're gonna make money on you we're going to lose a boatload of money on me and so the primary KPI right now in the health care system is length of stay because it has very perverse motivations and of course it's all billing codes and there's very few billing codes for wellness but they're starting to be some interesting signals so the Boeing Corporation two years ago you issued an ACO contract where they said here's 20,000 lives you major healthcare systems can bid to take care of these 20,000 individuals but oh by the way it's a fixed price contract so you're gonna take care of them and not raise your rates for five years and historically we raised our rate every year 12 to 16 percent so we bid on it we be in the University of Washington healthcare system the Providence st. joseph's healthcare system bid on it and off we go three years in providence pulled out because they couldn't figure it out and we at the university of washington system it's the first time in the board room i hear like how are we gonna keep these people healthy you know so actually trying to think about not optimizing treating illnesses but actually keeping people healthy so there's going to be some change there that's gonna have to be some change there's three drivers of human health three drivers of human health any sense of what they'd be exercise rest great any of the diet well you're generally spot-on set three drivers in the course of your lifetime thirty percent of your health is determined by genetics 60 percent behavior lifestyle environment ten percent the healthcare system and so think how crazy it is that we're devoting 18% of our GDP to the tiniest slice now go one level deeper so what's the primary tool physicians have pharmaceuticals right so there are studies that indicate of the top ten grossing drugs in the night States today the top 10 grossing the most effective helps one out of four people that take the drug the least effective helps one out of 24 so think of the billions that we're giving people these pills that are actually not helping in many cases hurting especially when they're combinations of them because that is where that science is to date and so we're in conversations with some pharmaceuticals right now a one example so non-small-cell lung cancer late stage there's an amine immuno of immunotherapy that's binary either it works or it doesn't work if it works you live if it doesn't work you die and they don't know why and so that pharmaceutical companies come to us and said we want to put 200 people that have this disease late-stage we want you Arabelle to create this dense dynamic data clouds for these individuals so we can understand is there a genetic profile that this drug actually works or doesn't work and then is there an interesting ohmic Dehradun that we can identify also that would help us understand that so in of one data has the potential to make the health care system much more effective and clearly pharmaceuticals I think I got a tangent there yeah so let's go a little bit more into that into into this area so I'm observing for example what craig Venter is doing with the human longevity lassitude and and that initiative as well so it seems that they you know they're doing you know it slightly it's a similar approach to what you have but on top of it implementing with the detail most advanced MRI scans and all stuff so where do you see from the data points that you are collecting overall today what are you missing one of the big things is that they memorize something else it's like memorial time data how do you see the field going one two years from now right so Craig Venters has that company called human longevity Institute and its price point is roughly $25,000 and you go to San Diego and it's cool and it's sexy but we've had a lot of people go through hli and a lot of people go through air valve and what they say the distinction is is that you assign a coach I talked to my coach some people everyday texting and asking with it and that coach is taking that calm data and translating it into actual recommendation based on what I'm willing to do and what I want to do so that's distinction one from a market perspective on the assay side Lee hood and his scientist at the Institute's assistance biology continue to have a lot of assays that they want us to do and so for participants we actually do a couple discovery assays where we can't share the data back because they're not yet from CLIA approved labs and it's not necessarily actionable but behind the scenes in addition to the blood saliva gut microbiome and we're looking at proteomics and metabolites and that's where there's some really interesting signals of when we look at these correlations of genetic risk then understanding what oming does that link to and so as I shared for the example of the person that had pancreatic cancer or the person who had leukemia that was by looking at proteomics of metabolites and we continue to do discovery work but part of it is a nascent startup that's funded by venture capital is that always trying to figure out that balance of where to make those investments but some of our partners now are coming to us and saying okay like discover it so back to Providence st. Joseph they have put a thousand of their employees into Arabelle for three years and they're doing a clinical trial where the saying okay we want to be a healthcare system that actually keeps people well and so we're putting a thousand of our employees in to learn what is the impact of scientific wellness in terms of reducing healthcare claims cost improving health overall another example would be Colgate so I didn't appreciate half of the world's population uses a Colgate product for oral care and so they have numerous brands so they heard about Lee hood they heard about air valve p4 medicine and came to us and said the future of oral care is going to be some degree in of one and their thesis is there's about five meaningful different types of oral microbiome and based on each of you in the room maybe fallen into one of these five categories they are developing tooth care or oral care that it'd be much more impactful for you based on your unique microbiome and so we're now involved in a clinical trial with them to understand how would we look at the overall system of an individual and determine what is the right oral so starting to be a lot of and if one experiments to understand we're unique and of course we're all treated exactly the same all right cool so you know like I'm very optimistic about their field right and I think that you thank you I've James against taking 18 percent of our you know and GDP and repurposing that on the long run if successful to something much more big than for for everybody that lives in this country and hopefully in the world I ask so let's go one step beyond right you know your personal thoughts on you know a cold initiatives by Aubrey de Grey on the whole candle longevity where the lines where the borders let's saying like a mile customer I follow all your recommendations advices yeah I mean the perfect Hannity no like where is the frontier beyond that tell me so the opéra de grâce directly it's the longevity your Institute and it's one of the most vocal you know like experience of basically solving every disease cardiovascular Alzheimer's that you know the major cancer right a major cause of that and then beyond that you know like a dressing like the senescence issues in the body and then you know I'm having a theory that at some time point you know it's not 120 years the maximum age of humans but it can be extended in you know for who knows how long right so your thoughts into that well I'm gonna give you I think an answer that's not gonna fit in so what we aspire to do is help people optimize your wellness and avoid disease for a life filled at joyful moments and actually what we do is every week in our team meetings coaches get up and share stories from individuals in terms of what they're actually doing and the first thing a coach is gonna do is say why are you here you know what's it mean to be healthy why do you want to be healthy and of course what Simpson is most people actually don't even think about that you know or have you thought about what you want to look like in 20 years and what you want to be doing excellent but not a lot of people have and so what we aspire to do a terrible is help people live full joyful you know robust lives where you're not folk done being ill and distribute well but we're actually especially me I'm not actually thinking that living forever is necessarily a goal or an aspiration and so we have a little bit of a joke internally aware right now if you get to a hundred and you're healthy and happy you tend to die relatively quickly and so our goal is to get you to 100 have you leave full rich lives and then you're on your own and you'll probably have a system failure and go quickly and so the we actually don't spend a lot of time thinking about beyond the hundreds base ok I'm just going one step foot a little s yeah why is your so that'll be the next start next okay okay yes yes yes but it also what's so interesting about that is that once again all of us have these different and of ones so another story with Alzheimer's so we've taken our roughly four thousand clients now we've created polygenic risk profiles their likelihood to have Alzheimer's and now we're diving in a saying okay what's unique and so we put them into five quintiles again and so the fifth quintile the people at highest risk started say what's unique about these individuals well it turns out the typical person is the age the amyloids in your brain start to increase and so there's an indication that that actually might be a protective function that helps preserve cognitive function so for quintile number five at highest risk this group as their agent their amyloids aren't increasing so you know once again how interesting is that when you think about these major chronic disease states that as we're all living longer what is the implication of what we need to be looking at to make sure we are living healthy lives as we age okay so i feel like one more question and then we'll give it to the audience okay so basically on scaling things among you can look interesting well what kind of personal coaches and everything else is it scalable right so basically I think you know all of us in this room are kind of fine-tuned to building artificial intelligence systems or at least observing them into a real lives and basically automating that we can sew and to scale right to building a world while you know infrastructure across the bigness of users right can you scale that well so the backend of how we think about scaling is that a lot of what your company's been extraordinary at and so when we initially launched the reason I went rated free and clear is that they had scaled within five years from serving 40,000 individuals a year to four hundred thousand individuals with the comfortable coaching program but of course the four hundred thousand is not very many so when we initially launched the company for every coaching call the clinical team spent roughly two hours preparing chart notes because we had data coming from 14 different labs giving the chart notes to the coach and then the coach coming up with recommendations so two hours for roughly a 45-minute call two hours of prep and post right now the prep and post is down to about 20 minutes and the way we've been able to do that is that we have machine learning that is tracking every single recommendation that the clinical teams making so now as the data is coming in about 70% of the recommendations are automated and so these exception rules that are going back out to the clinical team and our goal by the end of q1 is to get recommendations roughly at 95 percent automated now the control obviously is that the dietitian is licensed is looking at that data and saying does that make sense second thing is that free and clear their model is basically their coaches registered dieticians worked from home across the United States and so we see it to be a really interesting opportunity in terms of scaling that aspect third is leveraging technology to amplify the relationship so right now the individuals that are using the Arabelle app on average are checking in on the app 14 times a day and it's the app and the bot that's extending their relationship so as I said I'm working on sleep because like every startup CEO I believe sleep is not required and so I have a goal right now with my coach where I'm gonna quit working by 10:00 and I'm gonna go to bed by 11:00 so my phone tan the air of a lap pops up and it says swipe right if you're gonna quit working and then at 11 o'clock it pops up and it says you know swipe right if you're gonna go to bed well I often don't swipe but she sees my Fitbit data on my dashboard because it's all synced together and so you know I got a text from her after I've been on the road for about a week like Oh how's that going five hours a night sleep five days in a row but you're really being a great CEO my goal and your Ironman performance is probably right on track isn't it Clayton you know and so how does technology and BOTS leverage these objectives so this big opportunities there and then finally in the backend right now we're building the Arabelle Affiliate Network and the objective in the area now Affiliate Network is we already have physician groups and hospitals coming to us and saying okay we want to roll this out through our panels and our patients and what can be interesting about that it's also potential reduction in cogs because of the thousand dollars in assets right now and then of its reimbursed and so but it looks like as we're talking to his physician groups they might be able to get reimbursed anywhere from 250 to 300 dollars and so one it's about technology automating the recommendations to using technology to extend and enhance the coaching relationship not to replace it and then a work-from-home model and then leveraging other systems but we spend a lot of time thinking about it yeah cool second question is like you say your company's just two years old yes and I would say that's age for start-up so what's your end goal you want to be so three three end goals one the democratization of wellness and so our objective ultimately is that the wellness industry will dwarf the sick care industry and so this category that we're gonna launch not just by ourselves with a lot of partners that there will be more money putting into staying well and optimizing wellness and there'll be in treating symptoms and it'll be very affordable to people from all walks of life thank you one produced that much money as being sick right so tell me one more time being well was this how do you sell insurance in Iraq there are many emphasis into industry benefiting of somebody being sick exactly so the perverse incentives financial incentives our current system and so it one thing that will be interesting and I think will start to happen is much like the example of the Boeing ACO I gave you the state of Washington issued an ACO so we're gonna have to change the incentive of health care systems and what's happening right now is we're migrating from volume-based care which is where we're at right now to value-based care and we're the earliest stages of that but I actually believe that is where we're going to go and so when I'm out talking to health care systems and to pharmaceutical companies I say look at your outcomes Congress alone is not going to continue to put up with this we all know that the health care system today is broken way too much money's going in the challenges is that it's so slow to change that you know there's a start-up you always trying to figure out am i cutting edge for my bleeding edge and so we've got to figure out how to get the right partnership so that's why I was so excited that Providence st. Joseph said we're putting a thousand employees in because we actually want to change the system three weeks ago Spectrum Health Care System Grand Rapids Michigan so they invited me in to be the keynote speaker at their annual meeting so 300 people in the room all their board members their CEOs and you know I'm basically giving my talks a and you're the 10% but you're taking 18% of the GDP what's wrong with that you the physicians spent 17 minutes 17 minutes you can't help those folks in 17 minutes let's look at the drug forgive him after I gave that talk which was somewhat provocative you know they mutely said we want to form a joint venture with you we want to figure out how to introduce Arabelle to keep some body of individuals safe so we're definitely plowing early ground there and I don't I don't have a clear path and so the question is everything in life especially if you look at business it's gradually gradually then suddenly and when the suddenly happened a transformation takes place and you know Seattle we've driven a lot of them so think of market leader and so you know market leader what we were doing is trying to give people the keys to the Multiple Listing Service you know so my mom's been a realtor forever and I'm going so you know it used to be in the old days you couldn't buy or sell a house without a realtor because they had the keys to the MLS system so they had all the data and so Zillow came along opened up the keys and now we have companies like red fin and we as consumers when we buy and sell we go and have a conversation with our realtor which is very different than we did before they had data you know same thing with travel agents back in the day if you wanted to find the least expensive travel a airline ticket you had to go to the travel agent cuz they had all the data and so what's interesting about arabela's we're making our participants much more sophisticated understand individuals understanding their data so a lot of them go and have conversations with their physician which are much better educated conversations and so we believe also that one there's going to be changes by payers to consumers are going to demand a different level of engagement and expectation and then three as the prices come down and we figure out how to have conversations with people you know much like 23andme people are curious the top-selling item on amazon prime day top-selling item 23andme and so think about that you know consumers now as I said at the start they're interested in genetics related to ancestry we've got to get that bridge now genetics about staying well that's how we think about it I'm optimistic sorry actually one question I was related to all this which is the S on do you know how many like health dollars that are moving towards like flexible spending accounts because I intuitively feel like I don't know Google certainly told all of our employees you're probably going to be better covered under our flexible spending accounts than a lot of then like the dodgy health investment plan than you will be under most of the right for most cases just you end up like having less out-of-pocket expenses over the course of year and I started wonder if that's the case that there are more health spending dollars that are moving to people that have that the ability to make decision is that intuitively I think you're right I don't have that data a quick example they're into it so Intuit decided to launch air bail across their organization and the first thing they did is say okay we're gonna let two hundred individuals submit to it and roll in the program oh by the way we intuitive paid our employees participate in wellness programs we're in charge of a thousand dollars for air about and so we're like great so we drop on to the Intuit campus we're there for 48 hours and there was only 200 slots when registration opened an hour 10 minutes later all 200 were taken and in two it had objectives around BMI weight they had objectives around diabetes and so within six months we had exceeded both of those metrics by 50% so then they said okay we want to enroll another 200 and now they're rolling out throughout their whole company now what into it does is they put a thousand dollars a year into their employees HSA account and so they now can use that money to pay for the Arabelle program so we see more and more where companies are funding flexible spending accounts health savings accounts for people to deploy against wellness offerings they clean thanks again for joining us today of course question would love to hear your point of view on the data whether it's with our NGO or another company being used for memes that aren't consistent with your mission because I totally agree with the mission but think insurance companies using that for pre-existing conditions and the like so my old boss congresswoman Louise slaughter actually passed the Jena legislation and the Jena legislation cruz prohibits discrimination based on employment and health care doesn't prohibit discrimination based on long-term disability and life insurance so interesting our philosophy is is that you own your data and we will not share your data with anyone and the first thing that happens is that when your data comes in it's all de-identified from any personal health information so even if our datasets get hacked on the research side it's been stripped of all identifiable information and even these relationships we have with employers like into it or Colgate or Providence st. Joseph we you can't get access to your employees data and so there has to be a bright line because one if there wasn't people wouldn't have confidence about coming in to a part of what keeps me up at night is data security because we've got some of the most prominent individuals in the country both business leaders and elected officials in our program and they said you know if you're if my data goes out it would tank my stock price and so not only would it be a company killing event but we have eight values and one of our values is trust another value is privacy that said bad stuff happens and so you know it's a small company with only hundred seventy-five employees we have three undated security and a team we hire outside firms that come in and try to hack us down to where they'll call in to the customer care line and say oh this is Clayton I need some of those information and so we do a lot of things where we're trying to be focused on protecting that said answer the question they don't have access to it now but to be clear the Gina legislation well two things that we're doing right now right now because we are a health and wellness company we're only giving you genetic information related to health and wellness so we're not giving you information about Braca we're not giving you information about Alzheimer's were not giving you information about any of those highly impactful disease states so we're not even giving you information the Gina legislation for life insurance or for long term disability some insurance companies will say okay do you have this information and you know they're so they're asking you to disclose we're not engage you would not get that information from us because a we haven't disclosed it to you now the future is going to be interesting and what I would say is that you know the current FDA is being more thoughtful about understanding that genetic information should be given it to individuals and they should own their own data so there's been some vast transformations there yeah I think my question so a few the healthcare industry is a highly regulated industry and my origin Equestrian says want you to comment on the FDA regulations for example at one point FDA prohibits companies that report religions with cancer with Jeannie and then one point may mean it this man can live did and how to from your point of view how to overcome these challenges so the FDA is interested as I said I worked in Congress for a number of years and the FDA is a bit of a black box because there's not like this playbook that says ok this is this is what's happening and things are evolving so quickly and their positions are evolving especially with the new administration and so what we decided to do out of the gates of business is to embrace the regulatory practice so the first thing that happens when an individual signs up in every state we operate we have an independent third party physician in that physician orders all the clinical apps the clinical labs all our CLIA approved labs and then we have a licensed professional dietitian licensed in the state where you live coaching you on what she or he's allowed to practice so we made a business decision out of the gate to embrace the regulatory environment so we wouldn't have the 23andme experience we also because we're trying to change people's lives we believe is important to have the right professionals engaged in the conversation on the flip side the conference with senator patty Murray and Maria Cantwell and patty Murray is the ranking Democrat on the Senate health Human Services Committee so we've been going in and having conversations with her and her team and she actually hired a number of former FDA staffers to try to help us sort of figure out how do we have thoughtful conversations with the FDA on saying let's look at the fact that we are scientific data let's look at the fact that there's consumers that take this information and use it in a very powerful way and once again thank you to 23andme for being a leader in this space and they went through and now had a number of genetic variants approved where the FDA's looked at how they present that information the FDA has reviewed it said okay that is fine to give that information directly to a consumer the FDA is you know originally was concerned because there weren't licensed professionals involved you know there physicians reviewing it there weren't tight issues and so we've taken a different business model to embrace the current regulatory environment and completely play by the rules but it is challenging like the state of New York the state of New York is the only state that we cannot operate in and we're going through their regulatory process it's going to cost us hundreds of thousands of dollars and take about a year and think about that 49 other states we're completely embraced there whether to my environment New York is unique in terms of the amount of money we have to spend and the process and so there are some legacy states that are challenged but we love the state of New York in case you're watching is there a less yep I want reaction right sometimes oh I would really like to thank Clinton for coming here today to talk to us and I hope everybody enjoyed the talk I really loved all your questions I brought brochures and business cards over there if you want more information and thank you so much and thank you for being a member and loved your questions great to have the conversation with you thank you your presses were great you

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