A Seamless Way to Deliver Patient Education and Build Trust - David Neyhart, Co-Founder and CEO of Encap Health

Michael Carrese: Hi, everybody. I'm Michael Carrese, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

It's estimated that up to 40% of patients don't follow their doctor's treatment plan, which is obviously a barrier to improving their health. The reasons, of course, for this vary and include health literacy, social determinants of health, and the cost of care, but also, and this will be our focus today, the nature of the communication with their provider's office. We're going to be learning about a company called Encap Health, which is focused on increasing patient engagement through messaging before, immediately after, and between visits. 

I'm joined by David Neyhart, the co-founder and CEO of the company, who was previously a product manager in Amazon's healthcare group, working on new customer-centric healthcare initiatives. He left to start Encap Health after a personal health crisis and a calling to fix what he sees as a broken corner of healthcare, and we're very happy to have you with us today. Thanks for coming. 

David Neyhart: Thanks, Michael. I'm a fan of the show, and so honored to be on. 

Michael: Great. So we always start, as you know, with learning more about our guests and you have a really diverse career, which has included work in corporate finance, you've been involved in venture capital, launching companies, I mentioned Amazon... so what drew you to business early on, if you go into the ‘way back machine’ when were starting your career? 

David: Yeah, I think what drew me to business was really three things. The first is the familiarity of it. So my family was working in business. It just seemed like the natural next step. Number two is the financial opportunities and potential financial upside. Number three, and I think this is the most important, is the autonomy, the ability to have multiple careers, multiple different career paths through the same lens of a business education and career.

Michael: And it seems like that's come to pass. 

David: The optionality part. We'll see about the others for now. 

Michael: So, we talk to lots of entrepreneurs and get different answers to asking them about that experience of being a founder, because it is obviously a huge challenge. I’m wondering if you always saw yourself in that entrepreneurial role, or was that something that unfolded unexpectedly? 

David: I think I was always drawn towards the entrepreneurial role. A lot of things that being an entrepreneur really does well at is giving you autonomy and stimulation and sort of choosing your own adventure. Some of those things I really resonate with and it's hard to get those in a typical ‘corporate America’ job where you're just kind of told what to do and don't have a lot of ownership of it. 

I would say the unexpected part is that I'm working on a healthcare startup. My first foray into healthcare was when I was working in investment banking, doing mergers and acquisitions, and had a number of healthcare deals and they were just brutal. I remember my first one was a long-term acute care hospital system and seeing firsthand kind of the underbelly of the business of medicine, it just really turned me off to the industry. So, I would say the surprising part is that I've ended up back in healthcare and back in a startup in healthcare. 

Michael: Yeah, and part of the reason for that, as I referred to in the intro, had to do with a personal health crisis. Can you fill us in on that?

David: Yeah, absolutely. So, when I was a senior product manager at Amazon's healthcare group, working on new customer-focused initiatives, I got really sick. It was this sudden illness. My hands and feet were going numb. I was losing consciousness. I couldn't complete words and it was like this for months. I was in and out of specialists and Mayo Clinic and functional medicine doctors and ended up moving back in with my parents because ultimately I wasn't able to function alone. My heart rate was in the low thirties, I wasn't getting enough blood and oxygen to my body, and it led to a bunch of other downstream impacts.

Since this is a medical show, I don't want to bury the lead on what the diagnosis was, but it was a little bit of a difference between the diagnosis of exclusion. It was during the COVID period and it's, “Hey, you probably had a mild case of COVID that then lit off all this inflammation in your body and caused long haul COVID, and then from that, there's some other downstream effects of disrupting your gut microbiome, having a diverticulitis infection, ear infection, UTIs.” Also, the apartment I was living in Seattle was a little moldy, so just chronic inflammation probably lit on fire from COVID. 

Michael: Wow. 

David: But during this experience of a year of being in the cave of sickness I was faced over and over again with really how bad the patient experience is. You go in to see a provider today, you have maybe five to ten minutes, they rattle off a few things. Patients on average forget 70% of what's discussed in the room, because it's a stressful experience. There's white walls, the doctor's in a white coat costume. You're trying to think about how you feel and what to write down and you leave the appointment just really unsatisfied. 

The best case scenario was a nurse would go and print out a ten page black and white photocopied pamphlet and say like, “Oh, here's some more information on your health.” And you're like, “Oh, thank you.” You get back to your car, you look at it. It's mostly junk. It goes on the floor of your car and you never look at it again. 

Michael: Right. 

David: I had this light bulb moment at one point during this journey. One of my providers accidentally found a diverticulitis infection. They did a CT scan of my adrenals and said like, “Hey, your adrenals actually look good, but you have a raging diverticulitis infection. Did your stomach not hurt?” And I was like, “That was so low on my list of symptoms, I wasn't even going to complain about a stomach ache.” So, the doctor's like, “Great, you're going to be cured with three weeks antibiotics. We'll fix this diverticulitis infection. You'll be back.” 

He starts walking out the room and I was like, “Wait, wait, Doc, what if I have some more questions? What about like, do I need to change my diet?” He's like, “No, no, not really.” I was like, “Okay, okay.” And he starts walking out the room again. I was like, “Wait, wait, wait. What about probiotics? Do I need to take a probiotic? Like before or after the antibiotic?” He's like, “Yeah, yeah, take a probiotic.” I was like, “Okay, which probiotic?” Yeah. He's like, “I don't know. The nurse will send you the name of one.” 

So, fast forward a few weeks. I make the mistake of Googling ‘best probiotic’ so all of my targeted ads are best probiotics now. I'm completely overwhelmed, and just don't buy one. I'm eating oatmeal one morning and all of a sudden had full anaphylactic shock. My throat swells up. My tongue swells up. Can't breathe. Heart rate goes from fifty to one hundred and fifty in a few minutes. Parents rushed me to the ER. 

Michael: My goodness. 

David: And the ER doc was just like, “Hey, this is a food allergic reaction. Carry an EpiPen with you the rest of your life. You'll live.” Again, starts walking out. I'm like, “Wait, wait, wait, this is so unsatisfying. What do you mean carry an EpiPen the rest of my life? I've never had a food allergic reaction in my life. Like, what is going on?”

Michael: Yeah. 

David: So, he looks at his watch. “I've got a couple of minutes. Start writing this down.” He just rattles off like ten actionable things I could be doing. “This is probably caused from histamine reaction. The oatmeal you're eating had a bunch of dried fruit in it. Dried fruit is super high histamine food. Google ‘low histamine diet.’ Your gut microbiome is absolutely destroyed from all the antibiotics you've been on. It's going to take over nine months to heal. They don't know a lot about it, but here's a book where you can get some good information. You need to take a probiotic, but it has to be a low histamine probiotic. Here's the name of one you could get on Amazon.” And so that was a light bulb moment...that actionable information this random doctor was able to give me. Thank you again, Dr. White, by the way, in Athens, Georgia. 

If he didn't tell me that, I don't think I would have gotten that information from anyone. I went back to my primary care doctor and was like, “Hey, why didn't you tell me this stuff?” I feel like if it’s diverticulitis, then give the patient this information and it should just be automated. And he was like, “Yeah, I knew some of that. But as you know, I don't have time to sit there and give you the spiel on all of this information every time.” And I was like, “Well, I feel like we should automate that.” I feel like if you were a brilliant doctor. If you had thirty more minutes with every patient, what would you tell them? How would you educate them? What would you tell them on next steps and reminders for follow ups and other things that they could look into for diet, lifestyle and startups that are innovating in this space?

So, with that thesis of, hey, patient engagement is shockingly bad across the system; and then realizing that doctors know so much of this, but they just don't have the time or mechanism to get it to their patients, can we create a really seamless solution that can transfer knowledge from providers to patients in a way that can actually impact that behavior? 

That was the origin of Encap Health. I left Amazon a little over a year ago, and we've been building out the product and slowly getting traction and reaching a few thousand patients a month. 

Michael: Wow. What a story. I'm sorry to hear that you had to go through all of that, but you won't be surprised to know that we've heard similar stories over the course of doing this show the last couple of years. So, what is your solution? What have you come up with at Encap Health that you think will help facilitate that? What are some of the things that we can do to facilitate better engagement by patients, better understanding by patients and make it easy for providers to do a better job educating them? 

David: My big question, when I was leaving Amazon to do this was like, why hasn't someone done this? This seems simple. And it was just this naivete. It seems simple, but nothing is simple in healthcare. What we quickly realized is you need to align incentives across stakeholders. You need to align incentives for patients, and providers, and their staff, and the healthcare organizations they work for. So, we set all those individuals up and we're working backwards from how can we make this as easy for them as possible and what would get them excited.

On the patient front, we learned they didn't want an extra app, they didn't want a portal, they didn't want a password that they're just going to forget. They wanted an email to them. For providers? Not surprising: they wanted zero clicks. They're like, “This is great, but I don't have time to do anything. I'm not going to go to a different portal or click on a button. This needs to be fully automated for me.” For healthcare organizations? They need to make money. There needs to be a clear financial ROI for them, either through fee for service additional visits, through value-based care, increasing their HEDIS scores, or through a measurable reduction in healthcare costs. 

So, with that in mind, our product integrates with the doctor's EHR and then based on what the doctor's already entering into the HER -- ICD-10 billing codes, CPT codes, new prescriptions, visit notes -- we extract that and then say, hey, do we have content for these ICD-10 codes, for example. If so, send that to the patient automatically. There's no friction, no clicks, and that patient automatically gets a HIPAA-compliant email.

As an example, a patient goes in, she sees her doctor for osteoporosis, she maybe gets her prescription updated. She walks out the door. A few hours later, she gets an email in her inbox that says, ‘Dr. Smith's Osteoporosis FAQs and Tips.’ And she's like, “This is amazing. I just saw Dr. Smith.” She opens it up in the email. There's no sketchy links to click on like, ‘click here to view a message from your doctor.’ That looks like spam. Instead it just looks like a regular email, but it's fully encrypted for HIPAA. And in that email, it has the basic things you want to know about your health, right? Like, what is the condition, brief overview, a link to a Mayo Clinic YouTube video or maybe an Osmosis YouTube video, and then answers to questions such as what do I need to know about my medications; how can I get better in the future; how can I stay better right now? 

Then it can go into some more depth on some really critical things for patients. For osteoporosis, it's, hey, you need to be eating more calcium. You also need to be eating vitamin D with that calcium. You likely aren't getting enough of either of those from your food. Here's a link to some Amazon supplements. If you want to just get it from your food, here's a link to a website showing how much calcium and vitamin D ingredients are in the foods you're eating. Hey, you need to be working out, but don't just say working out, like, give some more specifics. For osteoporosis, it needs to be strength, load-bearing exercises. Here's a 30-minute YouTube video with an introduction to osteoporosis-specific workouts. Here's a new startup that is focused on at-home osteoporosis workouts. Hey, we see you're on Medicare Advantage. Here's a link to Renew Active, which is the old ‘silver sneakers’ program. They can give you discounted benefits. Here's a link to gym memberships where you can work on your osteoporosis.

So, the patient's getting this. They're like, wow, my doctor thought to send me all this information. This is actionable. I learned something. I'm empowered for my health. I can go do one of these exercise classes. So, that's the core product. And then following up, in a few months, it’s like hey, are you still taking your medication? Have you had any issues with it? Let us know why, or why not, and a button to click. Then when she's due for her DEXA scan in two years, a proactive email is sent out of, “Hey, it looks like it's time for a DEXA scan. As a reminder, this is why it's important and this is how you can easily sign up.”

Michael: And this is all stuff that’s labeled as coming from Dr. Smith's office. 

David: That's the beauty of it. We white label it from the doctor's office, so it looks like it's Dr. Smith. We're building this trusted communication channel because no one wants another email with somebody riding a mountain bike and taking a bite out of a shiny apple telling you to get your flu shot. Like, make it really specific to what the patient actually wants to know and something that can improve their health. 

Michael: Yeah. Wow. There's a lot there. You know, one thing that strikes me is it's just so convenient and useful that there is this list of things and links that's always there, you know? That it's sort of like a reference document that they can go back to and it’s easy to find because it's in their email. How do you guys decide what sources to pull from? What's your sort of vetting process for that? Talk a little bit more about the content side. 

David: Yeah. So, the hardest part of the content isn't that there's a lack of content. It's that there's too much content out there and a lot of it is just really bland. If you look at a WebMD article, it’s maybe ten pages describing something when really it could be one. So, how do we synthesize that information into nuggets and blurbs and then have a link to it if you want to go to learn more? 

It's like a lot of daily news emails, for example, that have like the headline, a sentence or two, and then a link to the Wall Street Journal article if you want to learn more. So we view that as our approach. Let's start with these top sources that are scientific papers, well-respected articles from major hospital systems, synthesize the information into the nugget that the patient can actually understand and then include the link if they want to go learn more to it. 

Michael: That's great. So, you've got to have some people there, writers who know health literacy levels and all that sort of thing to make it useful. 

David: Yeah, absolutely. We have our chief medical officer and the providers we work with look at the content. One of the beauties of our product is we give providers the option to change it if they want. They have a portal where we say, hey, here's our template content. This is what other doctors are using, but you have full autonomy to go in, add it, change it. You're a brilliant doctor. You have given your spiel to your patient in a way that you like it. So, if you want to talk more about the NASH diet instead of the Mediterranean diet or have some other nuances, go into your portal. You can edit it. It saves directly into our database’s HTML code and then going forward, all of your patients will get your exact voice and message. 

What we found is that for the most part, providers aren't tweaking or changing the content. They're like, “Oh, yeah, this looks great. This is so much better than the printout we've been using.” But they like the idea of being able to edit it and feeling that connection back to their patients so that if they read a book or listen to an article and want their patients to know about it, now they have a mechanism where they can drop it in and feel that connection to their patients and they're sending them their voice and the information that they want to share.

Michael: Yeah, that makes total sense. So, talk a little bit about the behavioral science aspect of this. How does that inform the messaging? And I'm curious, what kind of results are you seeing? You mentioned before that the providers need to see some ROI. So, what's happening there? 

David: So, the behavioral science part is really exciting for us. The bar is so low just to do anything in this space and have some little nudges. We have a few really good advisors who specialize in behavioral science and when I think about the core principles that we want to work on right now, the first one is from the patient perspective: what's in it for me? So this is the importance of context. We want them to open the email and get rewarded for reading this email. We want it to be the right amount of time, we want it to give them things that they are excited about so that next time they have a visit and get a similar email, they're excited to open it because there's something in it for them in opening that email. 

Then the next thing I'm thinking about is building trust with the provider. So, 90% of our patients are saying, I feel like my provider cares about me and my health after receiving this email, and that trust goes a long way, especially in certain groups that are historically marginalized, or don't trust their doctor, or they're just going home and Googling many things. So, building this level of trust of, hey, the doctor went out of their way to get me this information. I'm really getting value out of it. I trust what they're trying to do for my health.

And then the final part, when thinking about this behavioral science, is the ‘intent to action gap.’ There are care gaps in health...for instance a man who doesn't want to get his colonoscopy no matter what because it's a scary procedure. Well, okay, can we design interventions that say, ‘hey, this is why it's important, this is how we can make it really easy for you. Here's what to expect’ and deliver that in a way so we can nudge that patient to go and get the colonoscopy. 

We've been doing similar things with medication adherence. 50% of patients stop taking their statins after a year. So, we have a three-part campaign on statins of educating the patient on why it's important; what to do if there's side effects and the other options to explore. Then we’re checking in over a six-week period, just to make sure that patients are up and running on their statins and are not having major side effects, and if they are, having a feedback loop back to the provider so they can work on a different treatment option instead of the patient just taking their statins and the provider doesn't know.

Michael: Are you trying to measure patient outcomes at all, or what other metrics are you following? 

David: That is our North Star. Not measuring it right now. We just don't have enough patients and enough data or enough time history. Our North Star is we think we can make happier, healthier patients and improve their outcomes and right now, we just don't have enough data to really show. 

Michael: So, how do you see this evolving over time? What are you learning as you're getting off the ground that’s sparking ideas about, you know, ‘we could add this when we have time and resources?’ 

David: I think we're doubling down just on this simple approach. So many health tech companies, when you look at their website, you can't even tell what they do because they have twelve different things listed. They're chronic care management, they're remote patient monitoring, and they're meeting the patient where they are and all of these different things. 

I think one of the beauties of our product is that it's simple. It has a simple mechanism, a simple message. It's getting to patients. We have 75% open rates and people are liking what we're doing. So, when I think about this growing, it's, hey, we want more personalized content journeys. We want more proactive content journeys so we can actually get ahead of the curve and say ‘we see that you are prescribed Ambien and you report not sleeping well. You're at high risk for sleep apnea. Did you know 90 percent of sleep apnea is undiagnosed? Talk to your doctor about doing an at home sleep apnea test.’ 

Are there ways that we can connect these dots through the data that we're seeing and preemptively and proactively engage with patients so that they can improve their health outcomes? That's where I see this going ...is getting more patients on board, getting more providers on board, and then really being able to connect these dots through our interventions in a way that isn't currently being done.

Michael: I said at the beginning that you've been involved in launching a couple of companies. What surprised you the most about doing it in the healthcare space?

David: I knew healthcare was going to be hard. I underestimated how hard it was going to be.

And a specific on that is I didn't realize just how manual and how outdated so many things in healthcare are. 

Michael: Let's just stipulate for a second -- sorry to interrupt -- but fax machines are still an important part of healthcare delivery.

David: (laughs)It is wild. Just as a patient, you don't really understand what the doctor is looking at when they have their computer out in front of you, like how bad that interface is for the EHR. You have no idea that that EHR doesn't talk to another EHR, even if it's the same company and it's at a different hospital system. They're not connected. So I think, I continually have to have this mindset of everything in healthcare technology feels like it's about twenty years outdated, and I've been continuing to be surprised by that.

Michael: So, we're a teaching company, as you know, and we'd like to ask guests to give us some direction about a knowledge gap, a myth, something that they have particular interest in, where they would say to us, ‘Osmosis, you know, this would be a great video, or you could make a course.’ What would that be for you? 

David: One concept that’s near and dear to my heart would be to incorporate some new technology and some food as medicine and some holistic practices. I think that there is a tremendous opportunity to give everyone one of the new classes of continuous glucose monitors. Give it to them for a month, teach them how to use it, what it means. I think that that is an amazing way to empower patients to really see what the food going in their body is doing. 

Two quick data points: three tablespoons of ketchup has as much sugar as a Krispy Kreme donut. 

Michael: Wow.

David: I wore a continuous glucose monitor for about six months and it changed my life because I didn't realize the things I was eating impacted my life in really short term ways. As a specific, I was having a bowl of gluten-free…

Michael: Not oatmeal. I hope (laughs)

David: (laughs)Yeah, not oatmeal. Gluten-free granola. So, like around 9 PM, I was having gluten-free granola and I didn't realize that was skyrocketing my blood sugar. And then a few hours later plummeting and it was waking me up every night. I'm waking up at 2 AM with anxiety, like, “Oh my gosh, why am I awake?” And then finally looking at the CGM, you can see your blood glucose levels over time. It's like, “I'm eating this granola spiking my blood sugar and it's terrible for me. And then I'm waking up.” And so if there was a way, you know, to teach everyone how to use a CGM for a month...they're so easy and just really insightful about what's actually going on in your body.

Michael: That's a great idea. So, David, as we wrap up, we like to get advice from our guests to our younger audience about how to approach their careers in healthcare. You've had a particularly interesting career with some zigs and zags. Is there anything you've picked up along the way that you want to impart to our listeners? 

David: Yeah. So, I can't give advice for someone who's becoming a doctor since I've never been a doctor, but I can give advice that I was given as an investment banker, which I think is very relevant. And it's number one, go into the job eyes wide open. In banking, you're going to be working a ton. Just go into it knowing that that's going to suck and set yourself up for success, knowing that that's going to happen. For healthcare, go into it eyes wide open. Know that it has one of the highest burnout rates of any profession. Get mentors that are a few years down on your same career path and stage throughout that: so, five years older, twenty years older. Ask them, what they do to avoid burnout? How do they have satisfying lives and satisfying careers? So, just go in eyes wide open that it's a tough industry and it's ripe for burnout.

The second piece of advice I'd say is that options have value. What I mean by that is do things that can expand your career options outside of your normal scope of your job. That doesn't mean quitting your job and doing a startup, but it could mean getting involved in your local chapter of health tech nerds or getting involved in your local startup scene or a tech star scene and being an advisor for startups. There's a big appetite to have medical input in to startups and into companies, so if you can kind of moonlight and do that on the side, you can keep having your high paying medical career, but you're creating options for yourself outside of your specific field. And just in case AI comes and takes over all radiology jobs, you don't want to be without a role. 

So, go into your career eyes wide open, and options have value so create options for yourself.

Michael: Well, that's great advice and really one of the nice things about being in a healthcare profession is there's lots of different avenues to take where you can have a greater impact even beyond the wonderful impact you're having taking care of patients. 

Well, listen, we're going to have to leave it there, but I want to thank you very much, David, for being with us today. It's been really interesting and we wish you all the best with Encap Health. 

David: Michael, I really enjoyed the conversation and thanks for having me on. 

Michael: I'm Michael Carrese. Thanks for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We'rfosteoe all in this. Together.