May 11, 2023 • 27 mins
Joining MEternal are Nic and Trish Encina, the co-founders of Modelo Health. We'll be discussing the complications of high-risk pregnancy and how Modelo Health is using preventative medicine to improve maternal health outcomes in communities of color. We will also be discussing the benefits of precision medicine and what increases maternal health risks.
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(00:01):
Me turnal dot infants. Let's identifywhat are the factors are that are at
play, which ones are controllable oractionable, and let's give that information in
an adjustable way back to the patientsand to their clinicians so they can have
informed conversations about the best course ofaction for that pregnancy. Welcome to Meternal,
(00:23):
home to access in information for mothersof color. Joining us for the
podcast today are Nick and Trish andSena, the co founders of Modelo Health.
Today we'll be discussing the complications ofhigh risk pregnancy and how Modelo Health
is using preventative medicine to improve maternalhealth outcomes and communities of color. Welcome
to Meternal. I am Kenny Gibsonhere with my co host Jay Wilson.
(00:48):
Hello Ja, Hello, good tosee you, Kenya. Good to see
you two, and we are joinedwith two very special guests on the podcast
today, Nick and Trish and Sena, who are the founders of Modelo Health.
Welcome to Maternal. Thank you somuch for having us, Thank you
so much, happy to be here. Yeah, so tell us about Modello
Health. Yeah so, Madella Healthcame out of a story, our own
(01:11):
personal story. I was pregnant,and I was incredibly fortunate to have a
husband who's a science data geek andhis whole platform, I think of his
life is to protect his family,and I was his first true family member.
I had very I had challenges gettingpregnant, and we went into what
(01:34):
we would normally do, which is, how do we fix this? We
need to know everything. I think. We did what a lot of families
do, which is going to doctorGoogle. And we finally got pregnant.
And I was high risk because Ihad donated my kidney and I was above
thirty five years old, and sowe ended up very quickly realizing that there
was a huge break in information andunderstanding the information and access to inform nation,
(02:00):
and you know, as people whowould be relatively educated, we found
ourselves struggling and understanding pregnancy and what'sthe safest best way to feel have any
type of confidence or conviction, andhow we were going to do this.
We're like, how is everybody elsedoing this? Like, if we're struggling,
how is the rest of the worlddoing this? And very quickly I
(02:23):
became patient zero and my data geekhusband started what is we call prototype one
of modella health and I let himspeak to all of that, but I
was, you know, patient zeroover here. Yeah, it really stemmed
from a need. Trish was highrisk, and so very early on we
(02:44):
started receiving information from the clinicians thatwas somewhat ambiguous, scary, no clear
answer as to what it meant,what it could, what could happen,
or what we could do about it. So we did what most people would
do, which is turned to doctorGoo. And as soon as you do
that, you start getting even moreambiguous, more scary information with no end.
(03:06):
And so that's where for me,I turned to what my comfort zone,
which is information and trying to lookat it from the different lenses of
that I've built up over the yearsand building up my career, which has
been really crossing the spectrum in healthcarefrom discovery through drug development all the way
(03:27):
down to healthcare and public health.Yeah, and you spent some time as
a medical technician at Lorenzo Odone correctDona. Yes. Yes, he was
the basis of the movie Lorenzo's Oil, which was a genetic disease. This
movie came back. I think hecame out in the nineties. Susan Surrandon,
Nick Nolty and yeah, and so, so I came out of college
(03:50):
at the time and I met theOdonnais. They were looking for somebody with
my background to help take care ofLorenzo who needed twenty four seven care,
and so they trained me to bea medical technician and take care of Lorenzo.
I did that for about a yearbefore that gave me the inspiration to
go back to graduate school. Wow. Wow for the first time. For
the first time. Yeah. Yeah. So one of the things that we're
finding with this maternal platform is allthese connected stories, right, Like,
(04:14):
so your story and then we haveJay who was my co host in her
story, and like, this hasjust been this collective space for women of
color to share their journeys. SoI kind of want to go back to
your story a little bit. Andyou know what I guess was that one
progressive moment where you felt like,hoof, like we really have a solution
here and we have something to fightthe maternal health crisis. I think,
(04:36):
honestly, in my heart of hearts, that one moment that I felt,
Okay, I feel confident I cando this was with what my husband built
for me, and I was fortunate. It was a blessing. You know,
most people did not have someone whocan build a whole platform so that
they can feel safe. And thatplatform essentially was truly at its core,
(05:01):
was an Excel sheet with all thefactors that can play into my pregnancy and
then knowing where I was in eachone of those factors, my risk mays
think like a risk assessment, myrisk assessment, and every factor that my
pregnancy can like that can affect mypregnancy, and for me seeing it and
(05:25):
being able to advocate. When Iwent to my OB and I was seeing
at one of the top hospitals inthe country I mean actually in the world,
but definitely in the country, atmass General Hospital. And to be
able to have a conversation and feelinformed with an OB I had never been
pregnant, you know, I didn'tknow anything about anything OB centric, and
(05:47):
so to sit there and be ableto have dialogue, it was like wow.
You know, I think one ofthe biggest things that we hear a
lot from mothers that use the appis don't know what you don't know?
And so doctors are great at youknow, can I answer any questions?
You know? Some doctors can Ianswer any questions and you don't know what
(06:10):
to ask, and so to havethe questions to be to have the information,
I think for me, that wasthe most liberating part of my whole
pregnancy. Wow, I love thatyou said liberating. Right. When we
go into pregnancy, we literally don'tknow what's going to happen, right,
whether it's your first pregnancy or yourtenth. Right, every pregnancy is different
in the way it responds to yourbody. All of those things can be
(06:34):
very scary, right, But toknow that you created this app that gives
knowledge, it gives foundation for peopleto ask those questions and may feel intimidating,
it is a liberating experience. SoI appreciate you for actually sharing that.
So I wanted to kind of divea little bit into how you how
(06:57):
you got to the space of creatingtechnological solution, right, So in order
to reach people and give them theknowledge that you're giving them, what made
you decide to create an app forit? Like, was there any specific
things that came of, like,hey, there's no app for that,
(07:18):
let's make an app for that.That's a great question, Jay, that
would be me and the tachy Geekachkeeps referring to me. So, like
she said, the first manifestation ofthis was a spreadsheet. I was doing
nothing more than trying to keep mywife and are first born as safe as
possible. So I turned to theliterature and the scientific literature, and I
(07:41):
looked up risk stratification statistical models forvarious diseases from proclampsia to preterm birth and
many others. And when you startdiving into the math, you see that
some of the factors are more thanjust clinical factors. There are sociological factors.
There are a vioral factors, Thereare environmental factors if you have letting
(08:03):
your water, many other factors thatactually play into are you at risk for
preterm birth? And so that wasan eye opener for me, and immediately
I thought, there's zero chance wecan keep track of all this just by
thinking about it and keeping Tral inour minds. So I started putting it
onto a spreadsheet. And Trish wastruly patient zero. Where you know,
we were pricking her finger for blood, you know, checking her glucose level,
(08:26):
I think every other day, wewere checking her weight, her blood
pressure, and just putting it intomodels to make sure that we were within
range of what was safe. Ididn't want to discover something was going off,
you know, the standard rates ofbeing a safe range by virtue of
being in an emergency. I wantedto kind of get ahead of that,
especially knowing that she was already highrisk. So we built up that model.
(08:48):
We built throughout our pregnancy, reallythroughout that course, just educating ourselves
and where she should be, whatwe should be, keeping an eye for
reading the literature. And then thatgives us the motivation. Because we knew
we wanted a second child, wesaid, well, we should enhance this
and build it into something that shecan use during the second pregnancy that was
more useful something in a phone,and that's where we did that. So
(09:11):
by the time Roman came around,she was using it. And that's I
think the time when we decided,okay, I think this is something we
can expose to the rest of theworld. This is truly useful. We
weren't even sure if it was goingto be useful. Initially. It was
really just my approach is saying,I know data, so let's see if
we can use this to guide moreinformed decision making and take agency for our
own care. I would add Jaythat one of the things my husband has
(09:33):
a unique mental understanding for is discovery, right research. You know, most
people when you go on Google,you're not looking on page fourteen for the
white paper of whatever. You justyou know, googled nicked us. And
so he basically took aggregated all thepertinent, clinically backed scientific data that we
(09:56):
would want to know, right,but he went and found it very i
would say casually, but it tookwork. But he did that and then
realize and that was a part wherehe said that there's no way a human
is going to do that in realtime and know all these models in real
time. And that's not just theaverage model, that's even clinicians like it
is really hard to picture that onedoctor is going to be able to know
(10:20):
in real time for every patient live, all the models that can play out
and every risk that can play out. And also that doesn't help that the
body of medical knowledge doubles every seventytwo days, So even if they were
like the best doctor in the worldwith the most incredible brain, they would
(10:41):
have to spend a large part oftheir days just digesting all the new information.
And so that was when Nick obviouslyknew this was a tech issue.
Like and Nick has a really coolsaying that he says regarding how this is
not a human issue, not thatit's a human issue. How is it
that you say, hum, it'sbeyond human capability of being able to absorb
(11:03):
and digest and use this information inreal time, especially when you think about
how complex the issue of healthcare reallyis, right, I mean, doctors
are trained to use clinical information,sometimes genetic information, but we are becoming
more aware of the other health determinantsthat affect their care socioeconomics, right,
your access to good quality care,so social determinants, your environment. I
(11:26):
mean, we just went through whereand are going through a pandemic, So
who's not aware of the effects thatyour environment can have on your health?
And then finally behavior and so youknow there are people that focus on any
one of those individually. One ofthe things that we said was let's do
them all together. You know,we haven't come across anybody that's saying,
you know, this is a reallyhard problem, but we need to start
(11:46):
somewhere. And from my perspective,I come from the world of genomics and
precision medicine, which is really lookingat big data to understand patients much more,
where they are, who they are, and how we can keep them
healthy and UH and so when Iwhen I thought to myself what an ideal
scenario for me for healthcare would be, it would be to think of a
patient holistically. Let's identify what arethe factors that are that are at play,
(12:11):
which ones are controllable or or umactionable, and let's give that information
in a digestible way back to thepatients and to their clinicians so they can
have informed conversations about the best courseof action for that pregnancy. What is
causing the rise in maternal risk?That's a great question. It's it's a
(12:31):
multifaceted problem. You know, they'rethere are all kinds of different you know,
statistics out there obviously affecting different youknow, populations, women of color,
Black women disproportionately. I would saythat, you know, the literature
out there talks about um systemic racismin in the US. There are also
(12:52):
factors involved in uh, their culmorbidities. There are many factors postpartum as well
that effects are there. You wouldcome into socioeconomic issues, social factors,
there are environmental factors. So Ithink it's a complicated environment, which is
why it's not so easy to solve, right, And I think it probably
(13:13):
plays in different ways depending on theindividual, too. Different factors may play
more strongly than others. And Ithink that's one of probably the biggest reasons
why Nick and I felt that wecouldn't just tackle this. If we were
going to take on this issue,we couldn't tackle it just from one vertical
because it's complex. So we neededto create something that at the very least
(13:35):
we start attacking it with multiple facetsand not just looking at it with one
lens. Yeah, and information playsa big part, I mean, at
least I'm very biased from that perspective. We spoke briefly earlier on before we
started taping about maternal care deserts,right, And so there are a lot
of women in the US that livein places that don't have access to good
(13:56):
quality care, and many of themprobably we don't have access to good quality
information either, And so I wouldargue that if you don't have access to
good quality care, the least wecan duce provide you with information to be
aware of the increased risk that youhave where the nearest facilities are and what
choices you have and what things youshould be aware of. And so for
(14:16):
me, it starts with, let'sidentify risks, no matter where they come
from, no matter which healthy terminantthey're they're coming to you from. Let's
identify solutions. Let's guide you throughthat, and let's do that in a
way that's accessible to everybody, notjust whether you're you know you come from
you went to a great university andgot a degree, but you know,
are you a mom that just camehere and only speak Spanish, like you
(14:39):
don't even speak English? How dowe get that information to you as well?
I wish you had this app whenI had market will have it correct?
Absolutely. I think we often takethese things for granted, right,
I'm just having access to so manypieces of information, But I think you
(15:01):
touched on so many points, right. So, like you said, no
one's going to page fourteen of Google, right, but there's a reason that
those pages are there, right.So I just think about as much information
that I may have had prior tohaving my kids, there was still so
much I did not know, right, And I wonder if any of those
(15:24):
factors, if this app had existedwhen I had my kids, fifteen years
ago if I would have had adifferent outcome. You know, I'm a
four time survivor preclampsia, and Ilost two children prior to my first live
birth, and I did not knowwhat I did not know right, And
I had no idea that those experienceswould shape how I got to where we
(15:48):
are today, right, understanding mypurpose through this work and understanding how to
connect with other moms, women andbirthing people and fathers. Also through understanding
what does high pregnancy look like?Right? What does pregnancy risk in itself
look like? Right? You don'thave to be diagnosed as high risk to
know that there still is a risk, you know, Yeah, it's and
(16:11):
I commend you both Jay and Kennyon this amazing show and shining a light
on this terrible situation in the USand maternal care health crisis. It's um
you know even you know, we'vebeen doing this now for a couple of
years, and I'm sure you getthe same thing. When you talk about
the stats and you tell people thataren't involved, you get stunted faces.
(16:33):
People are like, no way,how can that be? They don't even
trust you. And what you needto do is just point them to a
simple link in the CDC where thestats are there, and then their eyes
just they open up and they lookat the state and they're like, how
can this possibly be happening here inthe US. And most people aren't aware
that. You know, being apregnant woman today, you're more than twice
(16:55):
as likely to die during pregnancy thanyour mom thirty years ago. And this
is a stat that only exists inthe US, and those stats are getting
worse, right, COVID are actuallymade it worse. Well, it's I
think COVID brought it to light.These stats already existed, but when we
put in you know, systemic racismand the way that people view the needs
(17:15):
of others, they weren't as awarethat they've already been there, Right,
these areas that have always been there, Like for me, like talking about
the state of New Jersey, blackwomen are seven times more likely to die
in childbirth in that state. Theonly state that's only states that are worse
to give birth in is Indiana,Georgia, and Louisiana. Right, But
(17:38):
these stats have been like this foryears, many many years, Right,
But there's only a few states thatare actually rolling their sleeves up taking accountability
and actually doing the work to startto reverse those statistics. I agree,
yeah, I mean, you know, the general stat you here is that
women of color two to three timesmore likely, but that's on average across
all states. Some do far worsethan others. And I think, you
(18:02):
know, one of the challenges too, because we talk about information, the
problem is that a lot of thisinformation, especially when you get into scientific
information, it's really hard to accessbecause you know, scientists, they do
their work, they do the research, and they publish and well known medical
journals in language that's very known toscientists, but it's not really that accessible
(18:23):
to most people just getting pregnant,trying to have a healthy delivery and survive
pregnancy. And so that's one ofthe things that we noticed when we started
doing our research is that I feltcomfortable reading those papers, but it didn't
mean that necessarily I could translate thatinto something that was useful for us and
definitely not to people that we caredabout. So a big part of it
(18:45):
is not only finding the information knowinghow to use it, but then how
do you deliver it to people thatare like, oh, I get it,
I need to do X, Yand Z. Yeah, the digestible
part of very scary, complex medicalinformation, I think is a challenge in
and of itself, and we're constantlyworking through how do we make this sound
(19:06):
less scary but still very important forsomeone to know. Sure, so let's
talk a little bit about like theuser experience when it comes to the app,
Like what is that like? Andhow important does a of a role
that is preventative medicine play and allof this. So I'll tackle the first
part and I'll let my precision medicineexpert over here tackle the second. So
(19:26):
with the user experience, one ofthe things we noticed in general is that
there were many, many pregnancy apps, and so when you look across the
pregnancy apps, you notice the commontheme of certain features. And if they
were getting thirty million moms on thisapp, then there must be things that
moms wanted, and so we decidedto do. Originally, we're like,
let's give moms the best, mostamazing information. We're like, it needs
(19:49):
to be more than that. Andso what we decided to do from a
user experience is not only give allthe hard science and identify all the risk
and all the areas. And whenI say areas, we're talking about the
five determinants of health, which unlessyou're in healthcare, I didn't know about
and I think most people don't knowabout. So we're identifying risk across all
(20:11):
five health determinants. But then we'realso allowing you to see your child.
And one of the elements that wenoticed was when we were pregnant, they
let you know the size of yourfetus in a fruit form, and I
think some other had others other andit was very difficult for us to figure
out, well, what does amango look like? And so Nick,
(20:32):
with his own hands, coded lifesize renderings of every fetus throughout the whole
journey of pregnancies, so you cansee the renderings of your fetus in life
size. We take you through afull journey, so think of like a
long linear line where you're pinged onwhat's most important, when it's most important,
(20:53):
the appointments you need to have.There's a calendar portion of it as
well, so you know when you'reshould be asking certain things. To the
question of what you should be asking, we make it easy. It's not
just one hundred questions you need toask. We put it throughout the pregnancy.
When you need to ask them throughoutthe journey we have and I think
(21:15):
this is a really great part becauseand what we have gotten as feedback is
the most useful is we have alibrary, and in our library there's a
Q and a section so you canactually ask questions to clinicians and scientists.
There is articles, and so whatwe did was we started with as a
(21:36):
startup, we started with all themost pertinent questions like what is Google producing
as the most things that people aregoogling the most, and then we answered
them from a scientific clinical standpoint,and also it's worth it we have clinicians
on our team as well, andso to those articles, they would also
identify questions that they felt were notwell answered. So that was one of
(21:59):
the key things. We're like,well, we don't want to just re
answer the same question, so wewould ask them what questions do you get
from patients often that you feel there'sjust not a lot of information out there
right, So that from a userexperience standpoint, the biggest I think headline
is that we are informing moms.But I think the biggest takeaway is that
(22:19):
we want to empower mom, Likewe want mom to get on the app
and when she closes that app forthat day or that moment, she's like,
Okay, she feels activated with convictionand confidence, because being confident when
you're pregnant, I think it's probablyone of the hardest things ever, Like
your hormones are everywhere, your bodyphysically is you're growing a human inside of
(22:41):
you. And then again access toinformation is challenging. So just feeling confident
and having conviction and the choices you'remaking for the life you're growing, I
think is a challenge and we wantyou know, one of the takeaways is
that mom feels confident and empowered.And then from the preventative standpoint, he's
(23:02):
an actual expert in the space.So yeah, So the first thing to
the experience when you log on,you know, there's a tutorial front just
telling you about what the information you'regoing to get, what the app is
about, and then you fill outa very simple questionnaire. I think it's
like seven or eight questions and thoseare really just the bare minimum that the
app needs to then start hyper personalizingthe information to you because at the end
(23:23):
of the day, this is yourown personal journey and the app is made
to reflect that. You know,a risk of preclaims you to one person
is different than a risk for gestationof diabetes for somebody else. So with
those questions, that allows us toeffectively start creating models of care. Hence
the name Adella Health it just meansmodel. Modella means models in Spanish.
And what the app does is itcreates these very sophisticated models around the patient
(23:47):
in real time. The more itlearns about you, the more it reconfigures
itself to no more, and thenit personalizes it to you. So when
you fill out that information, theapp then starts not only creating these models,
but then it looks out into thereal world into sources of information that
are trusted and authoritative from like theCDC, the EPA, Census Bureau,
all the sites. You'd be like, all right, this is authoritative information,
(24:10):
and it starts pulling it out inhyper personalizing it to you. So
this way we understand what the risksare to you and applying statistical models on
preclampsia or severe maternal morbidity or healthrelated social needs, and using all that
information start tailoring the experience to youso that we understand, Okay, this
is who you are. We seeyou and now these are the things that
the science is telling us we shouldkeep an eye on, and then it
(24:33):
does through It does that throughout thejourney, so that then we can kind
of look at, you know,everything from informative information that you know would
be interesting to you, like,you know, the development that you're going
through, what your fetus is goingthrough, all the way through again the
determinants. What are the things thatwe can keep an eye out, and
what can you and your clinicians oryour family do to try to prevent certain
(24:56):
things from happening and inter postpartum.That's great, that's great. So how
can moms access the app? Yeah, so one thing that was incredibly important
for us was that every mom hadaccess to the app. We did not
want there to be a barrier toentry, and so currently with the mothers
we're working with, they're predominantly sponsoredby the health systems that we are working
(25:18):
with, and so our partners takecare of that. However, on the
flip side, any mom right nowcan download the app on the Google Play
Store or the Apple Store and wecreated a special passcode just for iHeart Maternal
Mothers listeners, and it's iHeart MomsAll capital and you can access the app
(25:41):
for free. Where can people findout more about modelo Health. You can
check us out at Modello health dotcom. That's www dot mld E l
O h E A lt dot com. So anything else that you feel like
our audience should know, or what'sany way they can better equip them selves,
like for this journey through pregnancy,and like anything that we can do
(26:03):
to combat this crisis further that youcould recommend or share For me, it's
always going to bothe on too informationand I think understanding what you your body
are going to go through. Andso some of the other features we haven't
talked about in the app, orthings like, for example, we help
a mom through the course of thepregnancy fill out a and evidence based birth
(26:23):
plan. How do you plan andprepare for labor, delivery and postpartum?
You know whether you can communicate yourpreferences to your care team. We also
have a passport. So let's sayyou're a mom, you're traveling, you
go into labor, and you goto a hospital that nobody knows who you
are. How do you very quicklyconvey the most critical information those clinicians should
(26:44):
know about you in case you actuallydo go into labor and deliver in that
moment, And so a lot ofit is really informing moms of what this
journey is going to look like specificallyto them, and trying to inform and
empower them with information to take agencyover their own care, to have a
voice at the table so that theyare one of the active participants in deciding
what the best course of action isfor them. It's funny, before we
(27:07):
started recording, I mentioned to youon a total separate topic, a mother's
instinct, right like your your gutintuition. And I think there are a
lot of stories where mothers felt somethingwas wrong, somebody felt something was wrong
in the room, and I thinkit's vital to make sure you speak up
(27:30):
if something feels wrong. Just don'tgive up on shrine to be heard.
I think that's great. Yeah,and speak with confidence too. I mean,
one of our advisors is Charles Johnson, who founded four ker or four
Moms. Oh, Charles is great. He's such a great, great friend.
Me turnal dot infants. Let's identifywhat are the factors are that are at
play, which ones are controllable oractionable, and let's give that information in
an adjustable way back to the patientsand to their clinicians so they can have
informed conversations about the best course ofaction for that pregnancy. Welcome to Meternal,
(00:23):
home to access in information for mothersof color. Joining us for the
podcast today are Nick and Trish andSena, the co founders of Modelo Health.
Today we'll be discussing the complications ofhigh risk pregnancy and how Modelo Health
is using preventative medicine to improve maternalhealth outcomes and communities of color. Welcome
to Meternal. I am Kenny Gibsonhere with my co host Jay Wilson.
(00:48):
Hello Ja, Hello, good tosee you, Kenya. Good to see
you two, and we are joinedwith two very special guests on the podcast
today, Nick and Trish and Sena, who are the founders of Modelo Health.
Welcome to Maternal. Thank you somuch for having us, Thank you
so much, happy to be here. Yeah, so tell us about Modello
Health. Yeah so, Madella Healthcame out of a story, our own
(01:11):
personal story. I was pregnant,and I was incredibly fortunate to have a
husband who's a science data geek andhis whole platform, I think of his
life is to protect his family,and I was his first true family member.
I had very I had challenges gettingpregnant, and we went into what
(01:34):
we would normally do, which is, how do we fix this? We
need to know everything. I think. We did what a lot of families
do, which is going to doctorGoogle. And we finally got pregnant.
And I was high risk because Ihad donated my kidney and I was above
thirty five years old, and sowe ended up very quickly realizing that there
was a huge break in information andunderstanding the information and access to inform nation,
(02:00):
and you know, as people whowould be relatively educated, we found
ourselves struggling and understanding pregnancy and what'sthe safest best way to feel have any
type of confidence or conviction, andhow we were going to do this.
We're like, how is everybody elsedoing this? Like, if we're struggling,
how is the rest of the worlddoing this? And very quickly I
(02:23):
became patient zero and my data geekhusband started what is we call prototype one
of modella health and I let himspeak to all of that, but I
was, you know, patient zeroover here. Yeah, it really stemmed
from a need. Trish was highrisk, and so very early on we
(02:44):
started receiving information from the clinicians thatwas somewhat ambiguous, scary, no clear
answer as to what it meant,what it could, what could happen,
or what we could do about it. So we did what most people would
do, which is turned to doctorGoo. And as soon as you do
that, you start getting even moreambiguous, more scary information with no end.
(03:06):
And so that's where for me,I turned to what my comfort zone,
which is information and trying to lookat it from the different lenses of
that I've built up over the yearsand building up my career, which has
been really crossing the spectrum in healthcarefrom discovery through drug development all the way
(03:27):
down to healthcare and public health.Yeah, and you spent some time as
a medical technician at Lorenzo Odone correctDona. Yes. Yes, he was
the basis of the movie Lorenzo's Oil, which was a genetic disease. This
movie came back. I think hecame out in the nineties. Susan Surrandon,
Nick Nolty and yeah, and so, so I came out of college
(03:50):
at the time and I met theOdonnais. They were looking for somebody with
my background to help take care ofLorenzo who needed twenty four seven care,
and so they trained me to bea medical technician and take care of Lorenzo.
I did that for about a yearbefore that gave me the inspiration to
go back to graduate school. Wow. Wow for the first time. For
the first time. Yeah. Yeah. So one of the things that we're
finding with this maternal platform is allthese connected stories, right, Like,
(04:14):
so your story and then we haveJay who was my co host in her
story, and like, this hasjust been this collective space for women of
color to share their journeys. SoI kind of want to go back to
your story a little bit. Andyou know what I guess was that one
progressive moment where you felt like,hoof, like we really have a solution
here and we have something to fightthe maternal health crisis. I think,
(04:36):
honestly, in my heart of hearts, that one moment that I felt,
Okay, I feel confident I cando this was with what my husband built
for me, and I was fortunate. It was a blessing. You know,
most people did not have someone whocan build a whole platform so that
they can feel safe. And thatplatform essentially was truly at its core,
(05:01):
was an Excel sheet with all thefactors that can play into my pregnancy and
then knowing where I was in eachone of those factors, my risk mays
think like a risk assessment, myrisk assessment, and every factor that my
pregnancy can like that can affect mypregnancy, and for me seeing it and
(05:25):
being able to advocate. When Iwent to my OB and I was seeing
at one of the top hospitals inthe country I mean actually in the world,
but definitely in the country, atmass General Hospital. And to be
able to have a conversation and feelinformed with an OB I had never been
pregnant, you know, I didn'tknow anything about anything OB centric, and
(05:47):
so to sit there and be ableto have dialogue, it was like wow.
You know, I think one ofthe biggest things that we hear a
lot from mothers that use the appis don't know what you don't know?
And so doctors are great at youknow, can I answer any questions?
You know? Some doctors can Ianswer any questions and you don't know what
(06:10):
to ask, and so to havethe questions to be to have the information,
I think for me, that wasthe most liberating part of my whole
pregnancy. Wow, I love thatyou said liberating. Right. When we
go into pregnancy, we literally don'tknow what's going to happen, right,
whether it's your first pregnancy or yourtenth. Right, every pregnancy is different
in the way it responds to yourbody. All of those things can be
(06:34):
very scary, right, But toknow that you created this app that gives
knowledge, it gives foundation for peopleto ask those questions and may feel intimidating,
it is a liberating experience. SoI appreciate you for actually sharing that.
So I wanted to kind of divea little bit into how you how
(06:57):
you got to the space of creatingtechnological solution, right, So in order
to reach people and give them theknowledge that you're giving them, what made
you decide to create an app forit? Like, was there any specific
things that came of, like,hey, there's no app for that,
(07:18):
let's make an app for that.That's a great question, Jay, that
would be me and the tachy Geekachkeeps referring to me. So, like
she said, the first manifestation ofthis was a spreadsheet. I was doing
nothing more than trying to keep mywife and are first born as safe as
possible. So I turned to theliterature and the scientific literature, and I
(07:41):
looked up risk stratification statistical models forvarious diseases from proclampsia to preterm birth and
many others. And when you startdiving into the math, you see that
some of the factors are more thanjust clinical factors. There are sociological factors.
There are a vioral factors, Thereare environmental factors if you have letting
(08:03):
your water, many other factors thatactually play into are you at risk for
preterm birth? And so that wasan eye opener for me, and immediately
I thought, there's zero chance wecan keep track of all this just by
thinking about it and keeping Tral inour minds. So I started putting it
onto a spreadsheet. And Trish wastruly patient zero. Where you know,
we were pricking her finger for blood, you know, checking her glucose level,
(08:26):
I think every other day, wewere checking her weight, her blood
pressure, and just putting it intomodels to make sure that we were within
range of what was safe. Ididn't want to discover something was going off,
you know, the standard rates ofbeing a safe range by virtue of
being in an emergency. I wantedto kind of get ahead of that,
especially knowing that she was already highrisk. So we built up that model.
(08:48):
We built throughout our pregnancy, reallythroughout that course, just educating ourselves
and where she should be, whatwe should be, keeping an eye for
reading the literature. And then thatgives us the motivation. Because we knew
we wanted a second child, wesaid, well, we should enhance this
and build it into something that shecan use during the second pregnancy that was
more useful something in a phone,and that's where we did that. So
(09:11):
by the time Roman came around,she was using it. And that's I
think the time when we decided,okay, I think this is something we
can expose to the rest of theworld. This is truly useful. We
weren't even sure if it was goingto be useful. Initially. It was
really just my approach is saying,I know data, so let's see if
we can use this to guide moreinformed decision making and take agency for our
own care. I would add Jaythat one of the things my husband has
(09:33):
a unique mental understanding for is discovery, right research. You know, most
people when you go on Google,you're not looking on page fourteen for the
white paper of whatever. You justyou know, googled nicked us. And
so he basically took aggregated all thepertinent, clinically backed scientific data that we
(09:56):
would want to know, right,but he went and found it very i
would say casually, but it tookwork. But he did that and then
realize and that was a part wherehe said that there's no way a human
is going to do that in realtime and know all these models in real
time. And that's not just theaverage model, that's even clinicians like it
is really hard to picture that onedoctor is going to be able to know
(10:20):
in real time for every patient live, all the models that can play out
and every risk that can play out. And also that doesn't help that the
body of medical knowledge doubles every seventytwo days, So even if they were
like the best doctor in the worldwith the most incredible brain, they would
(10:41):
have to spend a large part oftheir days just digesting all the new information.
And so that was when Nick obviouslyknew this was a tech issue.
Like and Nick has a really coolsaying that he says regarding how this is
not a human issue, not thatit's a human issue. How is it
that you say, hum, it'sbeyond human capability of being able to absorb
(11:03):
and digest and use this information inreal time, especially when you think about
how complex the issue of healthcare reallyis, right, I mean, doctors
are trained to use clinical information,sometimes genetic information, but we are becoming
more aware of the other health determinantsthat affect their care socioeconomics, right,
your access to good quality care,so social determinants, your environment. I
(11:26):
mean, we just went through whereand are going through a pandemic, So
who's not aware of the effects thatyour environment can have on your health?
And then finally behavior and so youknow there are people that focus on any
one of those individually. One ofthe things that we said was let's do
them all together. You know,we haven't come across anybody that's saying,
you know, this is a reallyhard problem, but we need to start
(11:46):
somewhere. And from my perspective,I come from the world of genomics and
precision medicine, which is really lookingat big data to understand patients much more,
where they are, who they are, and how we can keep them
healthy and UH and so when Iwhen I thought to myself what an ideal
scenario for me for healthcare would be, it would be to think of a
patient holistically. Let's identify what arethe factors that are that are at play,
(12:11):
which ones are controllable or or umactionable, and let's give that information
in a digestible way back to thepatients and to their clinicians so they can
have informed conversations about the best courseof action for that pregnancy. What is
causing the rise in maternal risk?That's a great question. It's it's a
(12:31):
multifaceted problem. You know, they'rethere are all kinds of different you know,
statistics out there obviously affecting different youknow, populations, women of color,
Black women disproportionately. I would saythat, you know, the literature
out there talks about um systemic racismin in the US. There are also
(12:52):
factors involved in uh, their culmorbidities. There are many factors postpartum as well
that effects are there. You wouldcome into socioeconomic issues, social factors,
there are environmental factors. So Ithink it's a complicated environment, which is
why it's not so easy to solve, right, And I think it probably
(13:13):
plays in different ways depending on theindividual, too. Different factors may play
more strongly than others. And Ithink that's one of probably the biggest reasons
why Nick and I felt that wecouldn't just tackle this. If we were
going to take on this issue,we couldn't tackle it just from one vertical
because it's complex. So we neededto create something that at the very least
(13:35):
we start attacking it with multiple facetsand not just looking at it with one
lens. Yeah, and information playsa big part, I mean, at
least I'm very biased from that perspective. We spoke briefly earlier on before we
started taping about maternal care deserts,right, And so there are a lot
of women in the US that livein places that don't have access to good
(13:56):
quality care, and many of themprobably we don't have access to good quality
information either, And so I wouldargue that if you don't have access to
good quality care, the least wecan duce provide you with information to be
aware of the increased risk that youhave where the nearest facilities are and what
choices you have and what things youshould be aware of. And so for
(14:16):
me, it starts with, let'sidentify risks, no matter where they come
from, no matter which healthy terminantthey're they're coming to you from. Let's
identify solutions. Let's guide you throughthat, and let's do that in a
way that's accessible to everybody, notjust whether you're you know you come from
you went to a great university andgot a degree, but you know,
are you a mom that just camehere and only speak Spanish, like you
(14:39):
don't even speak English? How dowe get that information to you as well?
I wish you had this app whenI had market will have it correct?
Absolutely. I think we often takethese things for granted, right,
I'm just having access to so manypieces of information, But I think you
(15:01):
touched on so many points, right. So, like you said, no
one's going to page fourteen of Google, right, but there's a reason that
those pages are there, right.So I just think about as much information
that I may have had prior tohaving my kids, there was still so
much I did not know, right, And I wonder if any of those
(15:24):
factors, if this app had existedwhen I had my kids, fifteen years
ago if I would have had adifferent outcome. You know, I'm a
four time survivor preclampsia, and Ilost two children prior to my first live
birth, and I did not knowwhat I did not know right, And
I had no idea that those experienceswould shape how I got to where we
(15:48):
are today, right, understanding mypurpose through this work and understanding how to
connect with other moms, women andbirthing people and fathers. Also through understanding
what does high pregnancy look like?Right? What does pregnancy risk in itself
look like? Right? You don'thave to be diagnosed as high risk to
know that there still is a risk, you know, Yeah, it's and
(16:11):
I commend you both Jay and Kennyon this amazing show and shining a light
on this terrible situation in the USand maternal care health crisis. It's um
you know even you know, we'vebeen doing this now for a couple of
years, and I'm sure you getthe same thing. When you talk about
the stats and you tell people thataren't involved, you get stunted faces.
(16:33):
People are like, no way,how can that be? They don't even
trust you. And what you needto do is just point them to a
simple link in the CDC where thestats are there, and then their eyes
just they open up and they lookat the state and they're like, how
can this possibly be happening here inthe US. And most people aren't aware
that. You know, being apregnant woman today, you're more than twice
(16:55):
as likely to die during pregnancy thanyour mom thirty years ago. And this
is a stat that only exists inthe US, and those stats are getting
worse, right, COVID are actuallymade it worse. Well, it's I
think COVID brought it to light.These stats already existed, but when we
put in you know, systemic racismand the way that people view the needs
(17:15):
of others, they weren't as awarethat they've already been there, Right,
these areas that have always been there, Like for me, like talking about
the state of New Jersey, blackwomen are seven times more likely to die
in childbirth in that state. Theonly state that's only states that are worse
to give birth in is Indiana,Georgia, and Louisiana. Right, But
(17:38):
these stats have been like this foryears, many many years, Right,
But there's only a few states thatare actually rolling their sleeves up taking accountability
and actually doing the work to startto reverse those statistics. I agree,
yeah, I mean, you know, the general stat you here is that
women of color two to three timesmore likely, but that's on average across
all states. Some do far worsethan others. And I think, you
(18:02):
know, one of the challenges too, because we talk about information, the
problem is that a lot of thisinformation, especially when you get into scientific
information, it's really hard to accessbecause you know, scientists, they do
their work, they do the research, and they publish and well known medical
journals in language that's very known toscientists, but it's not really that accessible
(18:23):
to most people just getting pregnant,trying to have a healthy delivery and survive
pregnancy. And so that's one ofthe things that we noticed when we started
doing our research is that I feltcomfortable reading those papers, but it didn't
mean that necessarily I could translate thatinto something that was useful for us and
definitely not to people that we caredabout. So a big part of it
(18:45):
is not only finding the information knowinghow to use it, but then how
do you deliver it to people thatare like, oh, I get it,
I need to do X, Yand Z. Yeah, the digestible
part of very scary, complex medicalinformation, I think is a challenge in
and of itself, and we're constantlyworking through how do we make this sound
(19:06):
less scary but still very important forsomeone to know. Sure, so let's
talk a little bit about like theuser experience when it comes to the app,
Like what is that like? Andhow important does a of a role
that is preventative medicine play and allof this. So I'll tackle the first
part and I'll let my precision medicineexpert over here tackle the second. So
(19:26):
with the user experience, one ofthe things we noticed in general is that
there were many, many pregnancy apps, and so when you look across the
pregnancy apps, you notice the commontheme of certain features. And if they
were getting thirty million moms on thisapp, then there must be things that
moms wanted, and so we decidedto do. Originally, we're like,
let's give moms the best, mostamazing information. We're like, it needs
(19:49):
to be more than that. Andso what we decided to do from a
user experience is not only give allthe hard science and identify all the risk
and all the areas. And whenI say areas, we're talking about the
five determinants of health, which unlessyou're in healthcare, I didn't know about
and I think most people don't knowabout. So we're identifying risk across all
(20:11):
five health determinants. But then we'realso allowing you to see your child.
And one of the elements that wenoticed was when we were pregnant, they
let you know the size of yourfetus in a fruit form, and I
think some other had others other andit was very difficult for us to figure
out, well, what does amango look like? And so Nick,
(20:32):
with his own hands, coded lifesize renderings of every fetus throughout the whole
journey of pregnancies, so you cansee the renderings of your fetus in life
size. We take you through afull journey, so think of like a
long linear line where you're pinged onwhat's most important, when it's most important,
(20:53):
the appointments you need to have.There's a calendar portion of it as
well, so you know when you'reshould be asking certain things. To the
question of what you should be asking, we make it easy. It's not
just one hundred questions you need toask. We put it throughout the pregnancy.
When you need to ask them throughoutthe journey we have and I think
(21:15):
this is a really great part becauseand what we have gotten as feedback is
the most useful is we have alibrary, and in our library there's a
Q and a section so you canactually ask questions to clinicians and scientists.
There is articles, and so whatwe did was we started with as a
(21:36):
startup, we started with all themost pertinent questions like what is Google producing
as the most things that people aregoogling the most, and then we answered
them from a scientific clinical standpoint,and also it's worth it we have clinicians
on our team as well, andso to those articles, they would also
identify questions that they felt were notwell answered. So that was one of
(21:59):
the key things. We're like,well, we don't want to just re
answer the same question, so wewould ask them what questions do you get
from patients often that you feel there'sjust not a lot of information out there
right, So that from a userexperience standpoint, the biggest I think headline
is that we are informing moms.But I think the biggest takeaway is that
(22:19):
we want to empower mom, Likewe want mom to get on the app
and when she closes that app forthat day or that moment, she's like,
Okay, she feels activated with convictionand confidence, because being confident when
you're pregnant, I think it's probablyone of the hardest things ever, Like
your hormones are everywhere, your bodyphysically is you're growing a human inside of
(22:41):
you. And then again access toinformation is challenging. So just feeling confident
and having conviction and the choices you'remaking for the life you're growing, I
think is a challenge and we wantyou know, one of the takeaways is
that mom feels confident and empowered.And then from the preventative standpoint, he's
(23:02):
an actual expert in the space.So yeah, So the first thing to
the experience when you log on,you know, there's a tutorial front just
telling you about what the information you'regoing to get, what the app is
about, and then you fill outa very simple questionnaire. I think it's
like seven or eight questions and thoseare really just the bare minimum that the
app needs to then start hyper personalizingthe information to you because at the end
(23:23):
of the day, this is yourown personal journey and the app is made
to reflect that. You know,a risk of preclaims you to one person
is different than a risk for gestationof diabetes for somebody else. So with
those questions, that allows us toeffectively start creating models of care. Hence
the name Adella Health it just meansmodel. Modella means models in Spanish.
And what the app does is itcreates these very sophisticated models around the patient
(23:47):
in real time. The more itlearns about you, the more it reconfigures
itself to no more, and thenit personalizes it to you. So when
you fill out that information, theapp then starts not only creating these models,
but then it looks out into thereal world into sources of information that
are trusted and authoritative from like theCDC, the EPA, Census Bureau,
all the sites. You'd be like, all right, this is authoritative information,
(24:10):
and it starts pulling it out inhyper personalizing it to you. So
this way we understand what the risksare to you and applying statistical models on
preclampsia or severe maternal morbidity or healthrelated social needs, and using all that
information start tailoring the experience to youso that we understand, Okay, this
is who you are. We seeyou and now these are the things that
the science is telling us we shouldkeep an eye on, and then it
(24:33):
does through It does that throughout thejourney, so that then we can kind
of look at, you know,everything from informative information that you know would
be interesting to you, like,you know, the development that you're going
through, what your fetus is goingthrough, all the way through again the
determinants. What are the things thatwe can keep an eye out, and
what can you and your clinicians oryour family do to try to prevent certain
(24:56):
things from happening and inter postpartum.That's great, that's great. So how
can moms access the app? Yeah, so one thing that was incredibly important
for us was that every mom hadaccess to the app. We did not
want there to be a barrier toentry, and so currently with the mothers
we're working with, they're predominantly sponsoredby the health systems that we are working
(25:18):
with, and so our partners takecare of that. However, on the
flip side, any mom right nowcan download the app on the Google Play
Store or the Apple Store and wecreated a special passcode just for iHeart Maternal
Mothers listeners, and it's iHeart MomsAll capital and you can access the app
(25:41):
for free. Where can people findout more about modelo Health. You can
check us out at Modello health dotcom. That's www dot mld E l
O h E A lt dot com. So anything else that you feel like
our audience should know, or what'sany way they can better equip them selves,
like for this journey through pregnancy,and like anything that we can do
(26:03):
to combat this crisis further that youcould recommend or share For me, it's
always going to bothe on too informationand I think understanding what you your body
are going to go through. Andso some of the other features we haven't
talked about in the app, orthings like, for example, we help
a mom through the course of thepregnancy fill out a and evidence based birth
(26:23):
plan. How do you plan andprepare for labor, delivery and postpartum?
You know whether you can communicate yourpreferences to your care team. We also
have a passport. So let's sayyou're a mom, you're traveling, you
go into labor, and you goto a hospital that nobody knows who you
are. How do you very quicklyconvey the most critical information those clinicians should
(26:44):
know about you in case you actuallydo go into labor and deliver in that
moment, And so a lot ofit is really informing moms of what this
journey is going to look like specificallyto them, and trying to inform and
empower them with information to take agencyover their own care, to have a
voice at the table so that theyare one of the active participants in deciding
what the best course of action isfor them. It's funny, before we
(27:07):
started recording, I mentioned to youon a total separate topic, a mother's
instinct, right like your your gutintuition. And I think there are a
lot of stories where mothers felt somethingwas wrong, somebody felt something was wrong
in the room, and I thinkit's vital to make sure you speak up
(27:30):
if something feels wrong. Just don'tgive up on shrine to be heard.
I think that's great. Yeah,and speak with confidence too. I mean,
one of our advisors is Charles Johnson, who founded four ker or four
Moms. Oh, Charles is great. He's such a great, great friend.
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