Bridging The Information Gap In Patient Education - Jack Needham and James Naylor, Co-Founders of Sanctuary 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. 

Patient education is, of course, an important part of Osmosis' mission, which is why we're happy about having the opportunity today to learn about a relatively new company called Sanctuary Health that's helping healthcare providers tackle the issue, and it's a big problem. It's estimated that patients forget half of what their doctor tells them in appointments, and on top of that, health literacy rates are persistently low in the U.S. and globally. 

Sanctuary's co-founders, Jack Needham and James Naylor, are with us to describe its solution, which involves licensing ready-to-use education content to health platforms, payers, hospitals, and employers. We'll also be delving into how advances in AI technology are allowing a lot of customization of this material based on the patient's language, literacy level, and other factors. 

Thank you both for being with us today. It's a pleasure to have you. 

Jack Needham: Thank you, Michael. Great to be here.

James Naylor: Thanks for having us. 

Michael: So, Jack, I'd like to start with you. We'd love to learn more about your background and what first got you interested in going down the entrepreneurial path. 

Jack: Well, so James and I, to start very early, have known each other since we were about seven years old. We went to the same primary school together and then went to the same high school together, and then decided not to hold each other's hands for university, and we went to different universities. But that didn't last very long, and we both dropped out. 

But before we got to that stage, my passion for healthcare came from actually wanting to be a doctor. I broke my arm when I was twelve, twice in one year, and had three operations on it and I became fascinated with orthopedics and orthopedic surgery. Did a bunch of work experience here in the UK when I was sixteen. I won't tell you the surgeon's name, but he snuck me into surgery, which I wasn't allowed to do, and I loved seeing orthopedic surgery. It was more like a design and technology lesson with woodwork than it was with surgery, with people hammering nails and rods and saws everywhere. It was incredible.

But I didn't really want to work for the NHS here in the UK, so around sixteen, seventeen, James and I were doing this work experience, and I went and tried more corporate work experience, and really, really didn't enjoy that. We were at the same boarding school, and we came together and started exploring new entrepreneurial ideas. We riffed on a bunch of different things from what was basically Uber. We came back and told my dad after a day of ideating about Uber that we had built this new taxi idea. My dad was like, “Yeah, yeah, it's a massive company. Nice try, guys, go again.”  

I'll let James tell his part of the story, but then at the start of university, not really enjoying our degrees, we decided within about six months that this wasn't for us. So, we dropped out and started then working on an idea. 

We iterated into the healthcare space. It felt like a very, very logical place to be for me, having such a passion for it in my early years. Then, I'll let James tell his part of it.. 

Michael: Yeah, James, go right ahead. 

James: Sure. So, I guess two questions as part of that, and I can answer why an entrepreneur, and then I'm happy to go into why this idea, if that makes sense as well afterwards. 

I think a lot of Jack and my story does overlap in terms of why we went into this, and I would not be the co-founder of Sanctuary Health if I didn't know Jack. We definitely spurred each other on. But it really does, for me, go back to that work experience that Jack and I did. We were forced to do it as part of our school curriculum, and came out to London and worked in some large out-of-home advertising company. They did all the tube stations here, or subway stations as you call them in America, and bus stations. 

As a sixteen-year-old -- as I think they get a lot of sixteen-year-old interns to do -- I was running around the office making cups of coffee and cups of tea and doing data entry. I think as a slightly naive teenager, I met up with Jack one evening and thought, is this what corporate life is going to be like? I'm going to spend the next however long...five years of my life working, or studying, and then go and make cups of tea?

Obviously, it's a very naive viewpoint, but really, that actually made us think that maybe there's something else here. We're both very lucky. The reason why we went to Jack's dad about the idea is he's an entrepreneur and my dad is also an entrepreneur. I think growing up in entrepreneurial households, it shows that that's a career path that is available to you. I'd seen he had a lot more flexibility than I did running around making cups of tea. So, I think that spurred us on there. 

Then as Jack says, we were mucking about, thinking about ideas. We started actually in the wellness space, creating content for wellness platforms during COVID. Then I went through my own healthcare journey, getting diagnosed with a condition. It wasn't a severe diagnosis, but it was pretty scary. I was twenty-two at the time, and was told I had high blood pressure and had no idea what that meant. Left the doctor's office, remembered absolutely nothing from a twenty-minute appointment, and felt very much on my own. We can get into the story more, but Jack and I had experience developing very high quality content. In this instance, the onus was really on me to find information about my health. It was complex. It wasn't engaging. I found it hard to understand this information. Part of that really pushed us on to go beyond wellness into chronic conditions and healthcare. 

Michael: Well, it can be contradictory and confusing. I mean, people get on Google with whatever their symptom is, and predictably, you're going to run into the word cancer. Doesn't matter what it is -- a sore elbow or my ear itches or something. It does get kind of overwhelming and worrisome for folks. 

I should note, by the way, that the founders of Osmosis were both mates together in medical school and dropped out after the second year to start Osmosis. You guys are right up our alley here. Jack, why don't you pick up the story? Patient education is an area of interest. How did it evolve into the approach that you're taking?

Jack: Yeah. Well, as James said, we were making wellness content. James went through private healthcare in the UK, which if you know anything about the UK healthcare system, private healthcare is meant to be this kind of ten-star experience. If you have health insurance, you go privately. You're meant to get a different level of service than what's delivered on the NHS, supposedly. But it wasn't. James may have had a bit more time with his doctor, but actually, he was given the same bad education materials and had to find his way through this diagnosis. It was about this time last year, actually, or maybe the summer of ‘22, we came together and we thought that upon diagnosis, there's a huge asymmetry of information between the physician and the patient. 

As you begin to manage whatever chronic condition you've been diagnosed with, you go through this learning journey to a point where hopefully you're confident to whatever extent you can be to manage your condition. We just thought that that was a better way of taking a patient's hand and getting them to that confident place than what was currently provided. The reason we believe that is because we looked at the consumer world, and it was being done everywhere. Whether you're looking at YouTube and TikTok and video consumption platforms, they have an incredible ability, the creators on those platforms, to make really engaging content. 

Or if you're looking at companies that make content themselves - whether that's Masterclass in modern day learning, to Duolingo in language learning -- these companies have pioneered ways of gamifying learning and delivering incredibly engaging video experiences that the healthcare world had ignored up until today. As Osmosis knows, because you guys are making incredibly well-produced animated content. 

Our idea was, why don't we take some of these methods that have been pioneered in analogous spaces and apply them to healthcare in a way that's relatively normal? We set about essentially producing the biggest video library of healthcare content in patient education. We developed a content and learning strategy that I can speak more about. We spent the last twelve months up in it. We filmed for the first time last September. We've been building a library of video content to help patients understand their conditions ever since. 

Michael: Wow. You guys are moving quickly here. James, what kinds of videos are we talking about? What's the format?

James: Yeah. Just for a bit of context, I really run the product side of things and Jack manages the content side of things. Maybe I'll riff for a bit and then let Jack take over on the content side. Predominantly, it’s short-form content. I think that a lot of the information that you find online is long-form written content. Studies have consistently shown that long-form written content is less engaging than audio and more specifically video content. If we're thinking about how we can maximize impact with a patient, and really that's about ensuring that their information recall on that information is the highest it can be, that naturally led us to video content. 

Then we ran a number of studies just entirely putting our content out to patients. Again, what we consistently found was short-form video content at the highest engagement levels. We've got a one-to-one value exchange. What that really means is that in every video, there's one core piece of information that's being communicated during that video. 

For example, if you're diagnosed, let's say, with hypertension, we're not doing a whole forty-minute video on what hypertension is. We're breaking that down into really digestible, engaging, understandable videos that tackle one aspect of hypertension. Maybe initially, ‘what is the DASH diet?’ That one video is about communicating that piece of information. How to take your blood pressure, for example. Again, studies have consistently shown that if you break a video down into these smaller topics with one knowledge transfer, one learning outcome, then information recall and confidence levels around that information are consistently higher. So, that’s really the approach that we've taken with our content. 

Michael: And you have physicians delivering the content, is that right, Jack?

Jack: Yeah. I think when we sat down and tried to understand how we should go about making this content, I think people trust information coming from providers. There's an inherent trust between you and your doctor and we wanted to try and simulate that as best as possible. So, we did that by sitting down subject matter experts, whether it's on diabetes or hypertension, and getting them to communicate these relatively complex subjects in hopefully quite simple ways. So, we really prioritize working with doctors and helping communicate these subjects to patients. 

Michael: So, just on the mechanics of this, and James, let me direct this to you, how are you folks connecting with potential customers, providers, and others? And what's the pitch to them about how this can benefit them and benefit the end user and how they can integrate it into their business? 

James: So, when we look at content, there are two aspects that are really important. It's right content, right time. When a patient is diagnosed with a condition or told that they need to go ahead with a medical procedure, that is the point in time typically when they've got the highest levels of anxiety and probably are most likely to default to action and actually be incentivized to understand what is going on. The longer you leave that gap, I think the less engaged that individual will be, and maybe they lose hope as well in actually taking action to understand their condition.

So, we've got the content and then the mechanisms by which we do this... actually, our wedge -- as it's quite often known in the startup world -- where we really started was in the digital health space. This was virtual care providers, and there was a lot of money that went into this during COVID and even towards the tail end of COVID, and a lot of patients were receiving their care through video consultations, et cetera. We made it as easy as possible for these digital platforms to integrate content experiences into that platform. 

Without getting too technical, we used an API which sends you a data feed to feed our big database of content into their digital platforms, and also gave them a lot of flexibility to develop content experiences that worked for their patients. We've seen our clients develop really incredible ways of delivering content to their patients. Anything from interactive quizzes to developing portals for their coaches or providers to, after seeing a patient, share content with that individual that's tailored to them and handpicked by the provider. So, for us, really, I think flexibility is key. As we go forward and try to move more upmarket, which is part of our wider strategy, then I think it's about integrating into electronic health records and actually understanding a patient. 

For example, a patient comes in and is told that they need to have, let's say, a colonoscopy. There is information at the moment that is relatively standard for all patients that is really helpful to understand and a patient who comes in prepared for a colonoscopy has a better outcome, typically, and the procedure takes less time. So, that's great for the patient, and it's great for the provider as well. 

That can be automated through patient engagement software, for example, and integrating into those, and telling a patient, ‘take yourGolytelysolution and stop taking X medication’ for example. We think that if we can reach the patient at the right time with the right content, you're consistently going to see a more engaged population and better outcomes, versus traditional methods of giving pamphlets that typically end up in the bin. As you said, as great as it is, 50% of information shared by providers is forgotten by the time patients leave the door. So, we’re just trying to innovate on that. 

Michael: Well, a lot of the content is just written at a literacy level that's far beyond where most people are at. I plead guilty on this. I worked at an academic medical center in communications, and we were trying to achieve that goal of matching the literacy rate of most readers, and it's a difficult thing to do. We would run it through the software and see we were coming out, and it turned out that we were writing at a much more advanced level than we were intending. 

James: Just to hop on that, you know, I remember when we did a little test where we were running medical information through readability calculators, and we found content out there from very reputable sources -- including government sources -- that is written at college-level reading levels, which is, yeah, pretty amazing. And, you know, we talk about right content, right time. Right content doesn't just mean making it engaging, but as you said, literacy levels, language. I think it's 27% of the US first language isn't actually English and if you're communicating a condition with someone whose grasp of the English language isn't fantastic, then you can make that experience tangibly better by translating the content, dubbing the content, and that's also something that we spend a lot of time doing at Sanctuary Health as well.

Michael: Yes, that's a perfect segue, because I was just going to ask about that. I saw a video with one of your providers on camera, and they appeared to be speaking a language that was not their native language and for folks who have not seen this happen yet, the technology is quite amazing. In fact, I tried it myself. I provided an AI translation website with a thirty-second clip of myself saying nothing particularly important, and asked them to translate it into Italian. I sent it to my brothers and sisters, and they're like, “When did you learn to speak Italian?” They can clone the voice and they manipulate the lips so it makes it look like I'm speaking that language instead. So, you're tapping into some of this, as I understand. Jack, tell us how that's working. 

Jack: Yeah, I might take a step back for a second and just describe the problem that it's fixing. I've been writing an essay recently on who invented the first video camera and I was trying to think about what they would have thought of the AI-powered kind of translation video content today. Since the video camera has been invented, or even the printing press, you've had this problem with content which I've kind of called the ‘personalization paradox.’ Content has been a one-to-many industry in the sense that it is too costly to develop multiple pieces of content for every person, because these people will consume content in different ways. 

You know, if you take me and you, Michael, you have a history in healthcare and worked in academia. If we get diagnosed with the same condition, you're fundamentally going to want more information than me, and you might consume that in a different format. But it's too costly to the healthcare world. Your costs just increase linearly with every piece of content you make. It was too costly to make a piece of content for every individual, so you had this one-to-many content model where you just produced one that was as broad brush as possible to make all of the Venn diagrams overlap. 

I think now where we're going to, with AI -- whether it's applied to translation or video creation or script writing and written content -- is we are now able to personalize content in a way that was just never possible before. We could be diagnosed with the same condition theoretically, and at very minimal cost, you could get a completely different piece of content to me and it explains the condition in a way that you understand and in a way that I understand. So, that's how we're trying to use this in healthcare. And the first place I think is really exciting is within languages. 

Typically, translation has just been a super complex problem to solve for. We've been doing it recently. We've been trying to translate content into Arabic. There are different dialects all over the world. It's written in a very different way to the way it's spoken. We can now take content with AI and get it to a starting place where we can empower a human translator to do something in a much more powerful way and that's how we're really applying it to the language world. 

We're getting scripts translated, we're getting videos dubbed, all getting a kind of version one of these pieces of content done, and then bringing the human side of it into play where they can review this content, make sure it's clinically accurate, make sure the language is accurate and make any edits. But as James said, that means that there are populations of the United States and everywhere else in the world that we can unlock access to. We can give them access to health information in a way that they just previously would have never understood it, and I think that's a really, really powerful application of some of these technologies. 

Michael: Yeah, no, it's absolutely revolutionary in a way. In the case of Osmosis, they have thousands of these videos that you folks have referred to, made in English first, and they've translated it laboriously into a couple of other languages. Now with these AI technologies, that's just opened up an entirely different range of possibilities in terms of translation. For our company, the potential to reach literally hundreds of millions more people using an AI technology at relatively low cost is just incredible. So, we’re in really interesting times for those who are engaged in education. So, you're a relatively new business, how is it going? Where do you see it going? What kind of experience are you having? 

James: Yeah, I mean, it's really fantastic. To speak more generally about working in healthcare, the thing that is really fantastic about this industry -- although Jack and I have not had long employment careers -- even compared to the wellness industry is that in healthcare, people really care about solving the problem of the patient. The level of support that you see from other founders, other employees at these other companies has been really fantastic. As two young British entrepreneurs, you know, we wouldn't have been able to get to where we are without that level of support and help. Therefore, I really love being in this industry and actually being able to build a product where you can see an impact. 

For us, as I alluded to earlier, we really saw our initial success in the digital health space. These virtual care companies wanted to integrate content, and we made it very simple for them to do that. We're now at a very interesting point of time where we're at an inflection point where the way in which content is created and distributed is going to change pretty radically. Jack has obviously just alluded to this, but the cost of content creation is going to trend towards zero over the next decade or so. 

For us, there are really two areas that we want to focus on. Firstly, moving more up market. Although digital health has been a fantastic place to start, and we've got a lot of great clients there, it does only represent a small microcosm of where patients sit. So, our big push at the moment is building strategic relationships with companies that can help us reach health systems and payers, for example, and reach that broader market. 

Then on the product side, it's really about the personalization piece. We've got a purpose-built team of engineers who are really at the forefront of how AI can be used in content creation. I manage the product team, and a lot of what the product team and engineering team are building are tools to deliver more personalized care. I'm really excited about what that can look like. Whether that's feeding in anything from language, literacy levels, social determinants of health, for example. I don't just think this is a ‘nice to have’ but it's actually really important. If you're happy to entertain me, I can tell just a very brief story that really annoyed me. 

My grandma, three weeks ago, had a mini-stroke. She's fine now. Last year, she was told that she was prediabetic, so she goes to her healthcare provider. She is in her early eighties and is a small woman anyway. She asked, you know, what can I do to prevent this? And they said to her, well, just don't eat as much and cut out fats and sugars. It's like, she's a very small, frail lady. She went home and just basically cut out a lot of food from her diet and just became even smaller and even more frail. 

She was told to exercise more. She played tennis and golf anyway, and she then injured her shoulder playing golf. Although the intention of that nurse was, I'm sure, fully intended to help my grandmother, it just wasn't helpful and I think what you can do now is actually feed in more data points. You know, this nurse probably had fifteen minutes, if that, with my grandmother. If you can feed in more data points, really understand the patient, and then provide really specific education in the right way that's empathetic, I think you can really move the needle. 

Look, I'm not going to say that that would prevent my grandmother from having the mini stroke that she had, but it could have done, right? The level of education that she got was not good enough then, and I think there's a real opportunity for us to change that, and that's very exciting to me. 

Jack: Sorry, just to jump off the back of that, Michael, it's almost an unmanageable task for physicians and nurses. There's thirty-six trillion cells in your body. Nurses and physicians spend twenty years specializing to just get an understanding of one slither of how the body works. You specialize, and you're then left to communicate that knowledge in ten, fifteen minutes to someone that knows nothing about that subject. That is actually harder than rocket science, in many ways. 

So, you know, for that nurse that explained things to James' grandmum, she's been given a task that is set up to fail. We should have this content and these learning experiences and this health information as the foundation for all learning experiences in healthcare, because no one currently has the time to deliver the information that's needed anyway. 

Michael: Well, you're putting your finger on really one of the huge problems in healthcare and it's exciting and encouraging to see bright young minds tackling this issue. 

So, we just have a couple minutes left. We always like to wrap up with allowing our guests to provide some advice to our listeners. What's your go-to advice? You're both pretty early in your own careers, but you've been able to establish your own path. So, what are your words of wisdom? 

Jack: Yeah, I'm not going to stand here and try and do too much lecturing to your wonderful audience. I probably don't have too much wisdom to impart. But I think that one of the things that I'm kind of tentative to avoid is there's a lot of AI doomerism at the moment. Rightfully, in many cases, we're thinking about the complications that can come with AI and we're preempting them in a way that can actually, I think, prevent the benefits from really taking root. 

So, my only thoughts with how that applies to healthcare would be, I would encourage healthcare providers in the early stages of their career to really explore these technologies, think about them from first principles, and really understand how they can augment the way that they deliver care and scale that care to many, many more patients. Because I think the next ten years of healthcare could look vastly different to the previous ten years if we really throw away the fax machine and embrace these technologies in well thought through ways. 

Michael: James, what would you add to that?

James: I think that's a fantastic point. I think there are two small things, and I've only been on the other side as a patient. But I think on the one hand, going into healthcare as a healthcare professional, there's a lot of really great entrepreneurial talent and if you look at them, they're not two separate Venn diagrams. There's a lot of overlap there and some of the best innovations that we've had as a company have come directly from speaking with providers. 

You're the people who are at the forefront of this industry speaking to patients and if you have got that entrepreneurial muscle, I'd really implore you to really try and get involved with the businesses trying to solve problems because they're going to do a better job because you're speaking to them. I'd really implore you to do that. 

Then I think on the other side, I've only really been a patient, and I've spoken to a lot of patients building the products and you wouldn't believe the impact that well communicated information can have on an individual. I'm not saying this is the case across the board -- because it's definitely not -- but I think for some providers and healthcare professionals, it's a bit of an afterthought, and it really shouldn't be. So, understanding how to communicate healthcare information, I think, is a worthwhile investment to actually deliver better care. That would be my advice. 

Michael: That's well said. Well said. Well, listen, it's been a pleasure to meet you both and talk to you both today. I want to thank you for your time, Jack Needham and James Naylor, and we wish you the best of luck with Sanctuary Health. 

James: Thank you very much for having us. It's been really great to be here today. 

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're all in this together.