At-Home Cardiac Rehabilitation Gains Traction - Dr. Harsh Vathsangam, Co-founder and CEO of Moving Analytics

MICHAEL CARRESE: Hi everybody, I'm Michael Carrese. Heart disease remains the number one killer in the United States, with nearly one million people experiencing a cardiac event each year. Even though studies show rehabilitation after cardiac events improves outcomes and can even reverse the progression of cardiovascular disease, only about 20% of eligible patients engage in it. Well, today's guest is doing something to improve that number by using technology to make cardiac rehab more accessible and effective. 

Dr. Harsh Vathsangam is Co-founder and CEO of Moving Analytics, creator of Movn, a virtual cardiac rehabilitation solution used by several leading health plans and thousands of patients nationwide. He earned a Master's and Ph.D. in Computer Science from the University of Southern California and holds an undergraduate degree from the Indian Institute of Technology. Thanks so much for being with us today. 

DR. HARSH VATHSANGAM: It's a pleasure to be here. I'm looking forward to this conversation.

CARRESE: Yes, I am too. So we like to start with learning more about our guests. What first got you interested in computers and tech, and eventually, how did you find yourself in the healthcare space? 

DR. VATHSANGAM: That's a great question. Generally, I'm just a tinkerer by nature. Left to my own devices, I'll start opening up remotes and breaking apart bicycles. One of my earliest memories is actually cleaning my bicycle with my granddad and really enjoying that experience of taking it apart and putting it back together. We used to have VCRs in those days. We used to take apart VCRs and clean those, too. So I really enjoy spending time with technology and it also ties into my other passion, which is using technology to help people. 

I think that technology has tremendous potential to a scalably help a large volume of people with relatively less effort compared to the human effort that would be put in. I felt that it would be a good life mission to take my expertise in technology and combine it with the ability to help people. There's no better industry where people would benefit than saving lives and improving the health of millions of people across the world. That's what drove me to healthcare at that point. 

CARRESE: Tell us about how Moving Analytics got started. Was there a point at which you decided, "Okay. This is the problem I want to solve, heart disease,” or how did that start? 

DR. VATHSANGAM: Yes. When I was finishing up my Ph.D. in Computer Science…while I was a really good researcher, I didn't want to spend my life in academia. Publishing papers and writing grants was not my cup of tea. I wanted to put out products that could very quickly and tangibly impact patients' lives. If not for Moving Analytics, I'd probably have joined a Skunk-Works-type lab where we would have had a very similar setting. What drew me to startups, in particular, was the ability to combine impact with high-tech integration and the ability to very quickly grow the impact that you can have. That visceral connection: what you do today gets shipped out tomorrow, and then it helps people immediately thereafter. 

Moving Analytics is an idea that started because originally, as part of my research, I had built technology that could monitor physiological signals of the human body, such as caloric expenditure, blood pressure, and so on. The way I like to think of it is, we were a hammer looking for a nail. We had these neat algorithms, but we didn't know where to apply them. Through a chance meeting with the American Heart Association, they said, "Heart disease is the number one cause of death, the number one source of direct and indirect costs. We have this proven way to improve it.” 

That was the first time we heard about rehab, all of seven or eight years ago. We spent another two or three years really trying to understand what we had, being technologists and not being familiar with the healthcare industry. It was one of those cases where the more we dug deeper, the more we understood what an amazing problem it was, in terms of the impact it could have, but yet, how underutilized it was. That's what let us on the path to Moving Analytics and Movn.

CARRESE: Yes. Cardiac rehab is also interesting because it's such a vulnerable point in people's lives, right? They've just come through this tremendous scare, and the rehab gym and that team can really become incredibly important to their recovery—psychologically, as well as just from the work that they're doing that can improve their health. So there's that emotional overlay to it as well, I think. 

DR. VATHSANGAM: You hit the nail on the head. When you have a heart attack or heart surgery, you literally had your chest opened, right? You were maybe 10 seconds away from being alive or not being alive. That is a huge check on people's psychology because they're like, "Oh my God, I was this close. What does it mean for me?" At the same time, you also are likely confused because now you don't know what's alright, what's not alright, what's inappropriate. Can you exercise? Can you eat certain foods? You may also be depressed because you may come to terms with your own mortality in some ways.

I think what a lot of patients experience then is something that rehab can really tackle, which is, it connects you with that healthcare professional who acts as the navigator in your journey after you have an acute heart-related event. It gives you that medical resource who can help you discern what's good and what's not good, and more importantly, progress you and show you that, "Hey, you know what? It's not only that you recover. You could be even better than you were before the heart attack." Showing you that ray of light that you can go towards. 

CARRESE: That's very powerful. So, tell us how the technology works in this setting with this patient population? 

DR. VATHSANGAM: Cardiac rehab is a clinical behavior change program, where a patient, once they qualify, is connected with a professional, who's usually a registered nurse or exercise physiologist. The way we worked before Moving Analytics was, you would have to go to an outpatient facility, assuming there was space available and after a two-month waitlist, and once you got in there, you would be connected with a professional that would create a customized treatment plan for you. Then, you would have to come in three times a week for 12 weeks to get that treatment plan. That is a problem for a lot of people, because most people can't drive that often. They have to choose between taking time off from work and attending rehab. Oftentimes, there are cultural issues. We know that women and minorities don't attend these sessions as much because they don't relate to the environment they're in. What's happening as a result is that 90% of patients don't participate in these programs. 

The way Moving Analytics solves that is through better patient experience. If you qualify for the program, you don't travel anywhere. We ship a kit to you, which is everything that you need to get rehab. We have a tech support team that gets you to download an app, and inside that app is a connection to your coach. This coach uses this kit, the data coming in from the kit, and an interview with you, to create a customized program that you can do from the comfort of your home. As you use the devices and the kit, which include a blood pressure cuff, a weight scale, and an exercise tracker, the coach is tracking you, and continuously coaching you, through a combination of telehealth visits and text-based coaching. 

Why is that more powerful? One, it's more convenient. Two, it's behavior change in the context of your everyday life. You're not cognitively disassociating yourself when like you enter a rehab facility; you're making the behavior change in the context of your day-to-day chores and activities. That's where the experience really scores. We're seeing more and more evidence through our platform that we produce better results than facility-based rehab, because of the experience that we have. 

CARRESE: So, if you're talking about people doing rehabilitation at home, it brings to mind the question of the “haves” and “have nots” in terms of exercise equipment. Do you need to have anything, along those lines, to participate? How does all that work? 

DR. VATHSANGAM: Yes. Eighty percent of all exercises that our patients do are walking-based. I live in sunny Southern California, so you can walk all throughout the year. But if right now you're in Minnesota, in the middle of winter, what you can do is walk inside a mall or in other indoor locations. If even that's not possible, we also give you a peddler that you can do, or you can do chair or table-based exercises as well. 

Again, the emphasis is around meeting you where you want to be met as a patient, and working with what you have. That sometimes includes economic considerations as well, like not everybody can afford a gym membership or to buy an expensive weight rack. In that case, we would just make it work with a chair and two bottles of water. That would work as well. 

CARRESE: So, what are you seeing? What kind of results have come across?

DR. VATHSANGAM: The results with our program have been really astounding. When we've worked with multiple health plans and providers to validate our solution, we've seen that we have participation rates go from that 10–15 percent number to 60 or 70 percent. The completion rates have gone from 50% to 80%. So more people join these programs, and more of them complete them. We are also seeing that readmission numbers, that is the number of patients who get readmitted after six months from their first heart attack, is 50% lower than the people who did no rehab or facility-based rehab.

CARRESE: Wow. 

DR. VATHSANGAM: So not only are we reaching more patients, but the patients who we do serve, they stick to it and they have a much lower readmission rate. I think that also is linked to the sustainability of the behaviors that they generate. 

CARRESE: Do you think this transforms their behavior in ways that impact other parts of their life? Is that what you're saying? 

DR. VATHSANGAM: A hundred percent. The way we think of rehab, as I mentioned, is, it's a lifestyle change you're making, and that lifestyle change includes exercise, nutrition, managing your stress, managing your blood pressure, and if you're a smoker, quitting smoking. All of these are interdependent. Case in point, if you want to reduce stress, you not only meditate, but you exercise. Sometimes when you start eating healthier, you feel healthier, and you can exercise more. If you quit smoking, then your lungs are a little healthier. That means you're now able to go out more, and you feel better as a result of that, too. The important thing is we take into account that holistic nature, the holistic intervention, the whole individual, to put it simply. That's where the results are showing. 

CARRESE: Where does your growth come from? Are you working first through the insurance companies, or how are you getting people to become aware of this and sign up for it?

DR. VATHSANGAM: To make it work, we have to make ourselves a part of the ecosystem. That means making sure that our service is covered as a benefit from health plans. Making sure that—this, particularly, I think, for this audience, would be relevant—that doctors and nurses refer their patients, because it is considered a gold standard or class I indication. As part of the doctor referral, we educate several providers across the country, and cath labs, and cardiology offices, and so on. We work with them to say that, "Hey, at the end of the day, we're trying to do what's best for the patient. We know that we have all these benefits, and by the way, it's also covered by their plans.” In many cases, we negotiate zero-dollar co-pays, so it's free for patients. We try to bring the entire community at play to bring this change in terms of improving outcomes of their community members. 

CARRESE: Given the greater comfort level people now have with virtual healthcare and telemedicine because of COVID, are you looking beyond cardiac rehab for other applications for your technology? 

DR. VATHSANGAM: That's a great point. What we've seen is that patients in our program, 25% of them are no longer hypertensive, when they were hypertensive, and 70% of them are no longer depressed, if they were depressed at the beginning of the program. Now, you would have to think, where else are these kinds of results applicable? Our vision is that we want to build a service and a product that empowers every individual to live a life free of cardiovascular disease. That means anywhere where you need to enforce or bring about prevention by improving a patient's health, and specifically focusing on behaviors that can improve a patient's health, we would like to be that solution that solves that problem. 

I can really see us extending this model to high-risk patients: patients who are about to get a heart attack because they have multiple heart-related issues, or patients post-cancer recovery. Often, after chemotherapy, for example, your cardiovascular system takes a huge hit and so you need to bring it back up through rehab to improve it. For patients with congestive heart failure, to strengthen their cardiovascular system, so they can manage their heart failure a lot more. For patients with vascular disease as well. So to me, it's a huge universe that we can extend this paradigm to and this is why I'm really excited about the potential of where we can go. 

CARRESE: It seems like you've gained some significant traction here. Are you surprised or not surprised by the pace of adoption? Could you reflect generally about what this experience has been like, trying to introduce something new to the healthcare system? 

DR. VATHSANGAM: It's been a hard and tough journey, to be honest, because in healthcare the barriers to getting any technology adopted are much higher—and they should be, because you're dealing with patient lives, safety, and so on. But working within the US healthcare system, which is by all accounts, a very Byzantine system in terms of getting payer coverage and getting providers to refer, I think it's taken us a good three, four years to really establish the roots of our system before the tree can shoot up. Now, we're starting to see that tree actually starting to shoot up at this point. 

So, that's advice I would give anyone who's looking to work in healthcare: be very patient, but also be ready for a lot of hard work before you start seeing the results. But it'll be worth it in the end, because another day when you see the patients tell their stories and their outcomes, it makes it very, very satisfying. 

CARRESE: Talk to me about COVID a little bit. How did that impact your business? 

DR. VATHSANGAM: COVID was a watershed moment in our company's journey. Because of COVID, a lot of on-site rehab facilities shut down because of safety reasons, social distancing reasons, and so on. For a while, we and some other hospitals we were working with were the only rehab game in town. What that means is that, as hospitals tested our solution more—they were almost forced to test our solution more—they received a lot of validation that, "Hey, you know, what? This telehealth thing is not so scary after all. It's something that could actually benefit patients.” 

That was something that was great to change the perception of how providers view telehealth-based approaches. That has kept going at this point; no one is shy of telehealth any more. It's not a dirty word that you don't speak; it's accepted as a modality of delivery. I don't think it's the only modality, but I think it's opened up the possibility that this is now an existing modality, that it's a legitimate modality going forward. 

CARRESE: Yes. Well, as you know, it was an absolute revolution, the way telehealth was adopted in a matter of weeks when essentially a lot of that technology had been around for 30–40 years. 

DR. VATHSANGAM: Yes. I think it also accelerated the technological aspects of delivering telehealth, too. The vendors who deliver telehealth are forced to hold themselves to a higher bar, because now, so many healthcare professionals are using telehealth-based approaches. So I think overall, the field definitely moved forward. 

CARRESE: We're a teaching company and love to fill knowledge gaps. We love asking our guests if there's any topic—could be directly connected to your business or not—that you wish people understood, that they don't. A myth, a gap, that you would say, "Hey Osmosis, you ought to make a video about this topic.” What would that be?

DR. VATHSANGAM: From my own experience, I think what a lot of clinicians could learn—and this was a little true for me, too—is the business of healthcare: how economic decisions are made at the clinical level, and the hospital level, if you work in a hospital. The reason being, not that they're trying to save cost—ultimately, health care is a mission-oriented industry, so about helping patients—but by knowing how the system works from a cost and economic perspective, I think you would really be able to take advantage of pitching your innovation, and by aligning it against those incentives. Something around, like, "Hey, how are claims submitted?” As claims are submitted, “What does the expected billing rate looking like?” Oftentimes, I see clinicians think, "Oh, that's not my job. I've got a biller who'll handle this." But I think it really pays off to learn that, even if it's a couple of hours a week, because it makes you a better clinician, and it allows you to work within the system to get what you want. 

CARRESE: That's great advice, and sort of flows into the final question. Because we have a younger audience in terms of the student audience, but also people early on in their healthcare careers, we like to ask our guests to provide advice, generally, about meeting the challenges of this moment with COVID, but also, how to approach their career. Here you are, somebody who has been able to start and grow a company in a very complicated business, as you were mentioning. What would your advice be? 

DR. VATHSANGAM: I think the single biggest thing we've learned is that, ultimately, the reason why we are successful or have an impact as a clinic or healthcare services company is because of the relationship between the provider and the patient, which is ultimately a human relationship. It's about establishing that emotional connection between yourself and the patient, and vice versa. I think that the so-called “golden rule” applies, which is, treat others as you would like to be treated. I think there's huge value for someone if, in addition to the medical knowledge, they combined it with empathy and establishing that emotional bond with their patients. I think patients would appreciate it. 

Every patient's life is different. You don't know what they're going through. If they're angry, maybe they're just angry because they have a lot of pain and that's manifesting itself as anger. So that's where I think the power of empathy could really go a long way, both for the patient and for providers getting the outcomes that they want. That's I think the one thing that we've learned, and I always try to emphasize it as a lesson for anyone who wants to get into healthcare.

CARRESE: That's great advice. I'm sitting here wondering if when you were talking about, as a child, liking to take things apart—the bike, the VCR—figuring out what's inside, how it's working…do you feel you've done that with the healthcare system, in a way? 

DR. VATHSANGAM: Well, I'm still putting it back together. I'm not sure yet where all the pieces go, but I think, metaphorically speaking, yes. I think that's sort of what we've been doing in our company. I said it in jest, but I think what we're trying to do is put it back together the way we want it put back together, in a way that is improving lives, saving costs, and saving physicians' time and effort. To me, I think that's what healthcare innovation is about. 

CARRESE: Yes. Everybody listening is wishing you the best of luck with that, because we need a lot of folks like you in the system improving it. I'm afraid to say we're out of time, but I want to thank you very much for being with us today. 

DR. VATHSANGAM: Thank you so much. I really enjoyed this presentation. 

CARRESE: I'm Michael Carrese. Thanks for checking out today's show, and remember to do your part to flatten the curve and raise the line. We're all in this together.