Dan Weinstein is the CEO of Oshi Health, a digital therapeutic platform for the self-management of Inflammatory Bowel Disease, based in New York City. Dan is a serial entrepreneur, and was the Co-Founder and COO of Cohero Health, another digital therapeutic platform for respiratory disease, prior to joining Oshi.
Tim: Dan, tell us a little bit about Oshi Health, and what drew you to the business?
Dan: Oshi Health is a digital health startup based in New York. We’ve launched a mobile app called ‘Oshi,’ which is a chronic disease management platform for people with inflammatory bowel disease (IBD, which includes Crohn’s disease and ulcerative colitis). We launched the app in June and it’s available for free in the Apple and Android app stores.
Oshi helps people better manage IBD through 3 core pieces of functionality: Track, Learn and Ask.
On the Track side, we help patients keep track of their treatments and lifestyle factors which could impact their disease. We also help them track their symptoms.
On the Learn side, we have original content that’s personalized to patients. We provide information on how to manage the disease itself – and how to have a healthy, balanced life with a very debilitating disease.
On the Ask side, people can submit their questions directly within the app, and we have a team of gastroenterologists and IBD experts who answer them in a moderated forum within the app.
Two things to know about Oshi: Right now, we offer the first all-in-one mobile solution to help patients find better control and live better with IBD. But our mission goes much beyond that. IBD is really unique – we don’t know what causes it, and we don’t know what causes flare-ups. Patients will experience remissions – where the disease goes dormant and they feel fine, and then they’ll suddenly have a flare, and we don’t know what causes that. And even if we did, it’s a very personalized disease, so what causes a flare for one person might not cause a flare for another person. And what works to help one person control their disease might not work for other patients. So our grand vision for Oshi is to be the platform that helps build the knowledge of what are the most effective treatments — including lifestyle choices — for different types of people with IBD.
Right now there are about 11 million IBD patients around the world, and each one of them is running a little experiment on themselves – they are doing a clinical trial, in a sense, with an N of 1. They are trying a mix of medication, making lifestyle changes like sleep, diet, exercise and maybe they’re trying some non-traditional medicine. They’re desperate to find a way to control their IBD, so they’re trying a recipe of different things to achieve remission, and some of them are having success. Some of them are figuring out what works for them to achieve remission.
But, right now, they are the only ones who benefit from what they’ve learned. Oshi is enabling there to be 1 clinical study with an N of 11 million. Our platform collects the real-world evidence of ‘what are patients doing, and what are they finding success with to control their IBD?’ And then we can leverage that in the future to make recommendations for personalized treatment. So we should ultimately provide a newly diagnosed patient with the most likely recipe of things that will help them control their specific version of IBD, and then we will be the tool to facilitate their treatment, as well as track and manage it.
Tim: So with that in mind, what has the partnership or origination from Boston Consulting Group’s Digital Ventures team provided in the way of a head start for you guys?
Dan: We were launched in collaboration with a group within Boston Consulting Group called Digital Ventures. They’re a really interesting group that basically creates startups. They helped create our strategy, business model, and early product. So the very first thing they offered was acceleration. After a few months with BCGDV, Oshi was where a normal startup would have been after a year or two. We also had some very smart people helping us develop our plan and business model. We sometimes veer from the original plan – it’s healthy to do that – but it’s always helpful to go back and see, “Are we doing something that was originally envisioned, or are we doing something different? And is there a reasonable cause for us to be doing something different?”
Also, as an early-stage startup, one of the most difficult challenges is getting credibility and getting people to pay attention to you. It totally changes that dynamic when we’re able to mention that BCGDV was involved in our creation. We actually worked out of their really nice space in Hudson Yards for the first few months, so when we’re building our team and interviewing people, it was nice to be able to show off an amazing office space rather than my kitchen!
Tim: That was not the worst setup that I’ve ever seen. It was a pretty good situation in the beginning. Can you share an example of a patient use case with the platform that you guys have seen so far, from a success perspective?
Dan: Imagine you’re diagnosed with Celiac disease: It’s one of the worst days of your life, but it’s also one of the best days of your life because you finally know what’s wrong with you, and somebody can tell you exactly what to do to get rid of the symptoms you’ve been dealing with, but didn’t know how to fix.
The day you’re diagnosed with IBD is just a bad day, because there’s not a great story yet of what are we going to do about it. IBD medications are not ideal; they have really bad side effects, they don’t always work, and it’s hard to predict if they’re going to work for you. So it’s just a bad day.
What Oshi offers patients is some guidance on that dark day. One of the pain points is that patients don’t know where to go for credible, reliable information that pertains to them. Because with IBD, there’s not a lot known – and there’s a lot of misinformation out there. So on the Learn side of Oshi, we have content that helps educate patients – Oshi content is verified by IBD experts, it’s written by experts, it’s all credible information, and it’s personalized. We know if a patient has ulcerative colitis or Crohn’s, as well as if they are experiencing a flare or not experiencing a flare. We know which Oshi articles they’ve preferred in the past. Based on that information, we serve them a personalized news feed that gives them the most relevant information. That’s something that doesn’t really exist anywhere else, and that’s something that patients have really responded to, because they finally have a place to go for something that can really help them.
The Tracking features of Oshi help patients figure out what works best for them. So let’s say that a patient reads that avoiding gluten has helped other patients and maybe it can help them. We offer them a tool to track their progress on that specific regimen that they want to try, and we show them if it’s working for them. It also creates a report that they can share with their physician to make the office visit more productive. No more struggling to remember what happened 6 months ago, or dealing with “recall bias.” Instead, their treatments and symptoms are all mapped out on a nice report that they can share with their doctor to really individualize their treatment.
We already have 20,000 downloads in the first four months of launch, and it just shows you how much patients have been wanting a tool like this.
In the future, the use case will also include aiding with the challenge of IBD diagnosis. It can take years before a patient is properly diagnosed. Imagine a world where you have a tummy issue, you download Oshi and you use the app for a few weeks, and it helps you track your symptoms, helping you identify or screen for what disease you might have. The app could say, “Hey, this might be indigestion, or it might be IBD, or this might be Irritable Bowel Syndrome, which is a totally different disease, and they’re all managed differently.” So it gives you and your healthcare provider a little bit more insight into what the diagnosis might be.
Then, once you go to a doctor and you are diagnosed with IBD, today, there’s a standard of therapy that is tried, and it’s a lot of trial and error: Let’s see how you respond to this drug, and if it works, great, and if it doesn’t, okay let’s try the next drug. In the future, Oshi will have learned about patients like you, and we’ll know which drugs you’re most likely to have success with. And so it will get rid of that trial and error, and we can prescribe you something that is more likely to help you. Then Oshi becomes your tool to help manage that treatment regimen, and then you become a new data point in our global research platform, and we learn about how you respond to that treatment, and we feed our algorithm with more one more data point to make it even more accurate.
Tim: That’s great, that’s awesome to hear. What lessons have you learned from your last entrepreneurial go-around that you want to apply to your time here at Oshi?
Dan: The first thing involves hiring – which is very applicable for this conversation. This is now my 4th startup, and one of the things I’m doing differently at Oshi, based on what I’ve learned, revolves around hiring. I’m now older, I’m a family man, I have two small kids at home. So I can’t just work all day like I used to. I have to go home and be the Chief Diaper Officer. Recognizing that, I’ve hired a Chief of Staff, who can help me do some of the things that as a CEO I need to do: strategy, research, planning, and just someone who can help take the load off. That’s one hire that I made based on past lessons and that I’m thankful for. Another is a Finance and Operations Manager. Somebody who can be our office manager, but also close our books and help model different commercial opportunities. That’s something I’ve learned at my previous company – there’s so much work to be done around that stuff. It was I think the 2nd hire we made, and it’s just been tremendously helpful.
Tim, you’ve helped me think through some other staffing strategy. Especially with the Head of Partnerships role, which I think was a very clever hire. It was clear to me the work to be done, but it wasn’t clear to me how to manage it. Some early brainstorming sessions that I did with the Aequitas team really helped clarify the plan.
Tim: Thanks for the plug! Digital Therapeutics are pretty hot right now. What are you guys doing to bridge the mental gap on the consumer side, where traditionally some people view that the only way to get better is to take a pill?
Dan: I’m going to challenge this question a little bit. In the disease states that I know best – respiratory and IBD – patients really want to get better, and are very comfortable trying things other than traditional medication. Especially with IBD. IBD patients are desperate to get better, and they are trying anything they can to do it. But from both experiences – especially with IBD – the thing we hear the most is that patients want to feel in control of their disease. And a platform like Oshi helps them do that. Just giving them the tools to track what they’re doing helps them feel in control. So I argue that for users – for patients – if you apply good user-centric design and you listen to patients when building your platform, and you incorporate that feedback, patients will love what you’re offering. That’s been my experience at Cohero and at Oshi.
For me the challenge with digital health is not the patients, it’s the enterprise customers. Whether that’s an at-risk health system, or a payer who has a financial interest in better managing their patient populations with chronic disease – they’re the hardest to convince because you need to have the clinical evidence showing that your platform actually does improve outcomes. The only way to address that is to be a real, science-based therapeutic company, and that’s what we’re doing at Oshi. We have a Chief Medical Officer. Our platform is being used in a clinical study out of the University of Edinburgh. We’re also preparing to do a randomized control study, which shows that patients using Oshi have better outcomes, and hopefully reduced costs, and we’re going to publish that in a peer-reviewed journal. Then, we’re going to go after those tougher enterprise customers, with the data packet that you need – that’s the only way to convince them.
Tim: And I think you started to touch on it a little bit earlier, with respect to culture – what aspects of your culture are you looking to hold onto as you grow?
Dan: Startups are fun! It’s a very naturally motivating place to be. We are a small team where people can make a tangible impact on the creation of a company, and our entire mission is to improve the lives of people who really have it tough. So it’s a pretty easy place to get people motivated and excited to be, especially at the early stage where you’re creating.
So to answer your question, the aspects that I try to hold onto as we grow – the very first one is fun. I want people to enjoy coming to work, being with the people that we have here, and doing what we do. I want them to feel that there’s a purpose for what we’re doing, that we as a company have a meaningful objective, and that they have a place to make an impact on that objective. As CEO, I think if I do the hiring part of my job well, it makes the rest of my job easy. So I spend lots of time on hiring, and interviewing maybe more people than other people would. I like to ask people to do homework and do some real work, to see how we work together before making any final decisions.
Then, once the team is hired, I like to recognize people for the impact that they’re making. We actually have an employee of the month! When people do something big for Oshi, we recognize them publicly and put their picture on the wall.
Also, to help keep people inspired, I find it helpful to have them hear from the people we are focused on helping. We had a workshop last week where we sat all day learning from patients about the challenges of having IBD. Oshi shut down – everybody, all hands were there, with laptops closed. I wanted everybody there to hear from patients directly. And that got people really excited and motivated about what we’re doing at Oshi. And then we had a couple beers afterwards, which always helps.
Tim: Beyond that, what keeps you up at night?
Dan: I love being an entrepreneur – to me there’s nothing more exciting or fun, or that has the same potential for making an impact in a positive way. But the definition of entrepreneurship is that you’re operating in unknown territory with a limited amount of resources. I have a chart of our cash burn, and it ends at some point if we don’t get customers or if we don’t raise more money. So that keeps me up at night, just knowing that all these people’s jobs and our mission of creating something meaningful for lots of people… if we don’t play it right, we can miss out.
And I find that it gets harder and harder to sleep as you get closer and closer to success. It’s all just a big dream at that early stage of a startup – you’re just building something, and nobody expects you to really make it, since most startups fail. But as it gets more and more real, and you start having more and more success, and you get closer and closer to achieving your goal, for me that’s when it gets harder and harder to sleep, because that’s when there’s more to lose. The thing about entrepreneurship is, you never get to turn off. Even when you are not working, there’s always this voice in your head saying, “Is this the one hour when if you turned off the TV and sent one email, it will be the difference between being successful and not being successful?”
Tim: What else, if anything, do you want people to know about, in terms of how you guys should be thought of, jobs that you want to hire for, people you want to hear from, partners that you’re looking for…?
Dan: One thing we didn’t talk a ton about is, the real unique thing that we’re doing is collecting real-world evidence on a disease that is very personalized in nature. So kind of like Flatiron Health – they have a product that is useful – but their real value to the world is that they are collecting data about lots of different patients with cancer – which, like IBD, it’s becoming a very personalized thing, where you treat each individual’s cancer, not just cancer the disease. It’s a model that’s pretty new.
At Oshi, we’re collecting data that is directly reported from patients, to build the data set of real-world outcomes to learn how to personalize treatments. That means we partner with a couple different types of people. First are people who care about better managing IBD, so that’s pharmaceutical companies, that’s healthcare providers, that’s actually also OTC companies and nutrition companies. We also have a research mission, so we partner with companies who provide genetic sequencing, companies who do microbiome sequencing, and health insurers, and pharma companies, on the R&D side, because we have a unique data set that’s never existed before.
The current thinking with IBD is that it’s this complex relationship between a person’s genetic history, their lifestyle, what their diet is, their microbiome, maybe a certain event in their lives that impacted them. The best way to manage it is likely a combination of the food that you’re eating, the medication you’re on, the way you live your life, if you’re getting enough sleep, if you’re controlling your stress, etc. So it’s a particularly complex disease that needs information beyond what you get from a randomized controlled study of a pharmaceutical product.
Nobody’s going to do a large randomized controlled study for measuring how stress impacts patients because it costs millions of dollars to do that. And no one company benefits, so who can justify funding it? So there’s just a big gap in the research of understanding the lifestyle component.
We’re collecting that data set, based on real-world patient data, and also tying it to effectiveness of traditional medications. It’s a new paradigm that we believe will lead to a much better understanding of how to treat people with IBD, so that they experience a far better quality of life!