#Twinning

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to Tech It To The Limit, the humorous and surprisingly informative podcast that

(00:22):
makes digital innovation and healthcare as entertaining as it is relevant.
I'm Sarah Harper.
And I'm Elliot Wilson.
And we're here to pull back the curtain on the world of digital transformation in healthcare.
Don't worry, you don't need a medical degree to join in on the fun.
Just a sense of humor and a penchant for all things health tech.
So buckle up folks.
It's time to...

(00:42):
Tech It To The Limit.
What's up, Elliot?
What's up, Sarah?
Welcome to episode nine of Tech It To The Limit.
That was some good job getting the number right this time.

(01:03):
I know, I was actually really impressed with myself on that one.
Thank you very much.
Yeah, I only took you 40 years to learn how to count.
I'm sorry, that was harsh.
Yeah, no, Alex, it feels...
It's okay.
It's okay.
It's so good to hear your voice again.
At the end of the year, it is December.

(01:25):
Well, you know, I'd like to know, you know, in my household, we celebrate Christmas.
In your household, you celebrate Hanukkah.
So in our households, we celebrate a version of Christmas, right?
But I feel like for our listeners, they may not necessarily celebrate that.
And that's totally wicked cool.
And in America, at least where you and I are both based, the most inclusive holiday that

(01:50):
I'm aware of is Festivus.
It's Festivus for the rest of us.
Festivus for the rest of us.
I just wanted to know, what do you want for Festivus, Elliot?
Oh, gosh, no one's ever asked me that before.
What do I want for Festivus?
Are you sure George can stand?
I didn't ask you.

(02:16):
You know, I...
Here's what I want.
What I want for Christmas is...
Festivus.
All I want for Festivus is, aside from my two front teeth, I want some telehealth extensions,
baby.
That's what I'm looking for.
Are those like hair, like things you put in your hair?
Or what's telehealth extensions?

(02:38):
Telehealth extensions.
Yes, synthetic.
Synthetic extensions from my head.
No, for those who may or may not know, we have been living on the brink of this telehealth
cliff since 2020, where every year we hope and pray that some flexibilities that were

(03:01):
given to us during the throes of COVID, allowing people to bill for telemedicine or to take
advantage of certain tax provisions using telemedicine were allowed.
And they've been renewed at this annual pace, and we've been advocating for them to be made
permanent for a long time now.

(03:23):
And finally, Congress has put out their continuing resolution.
You know, in...
Practic, not a real budget.
No, not a real budget, just a continuing resolution, like Congress does.
But it does in contain, and this came out like today, does contain extensions for some
of these flexibilities, two years for the Medicare telehealth flexibilities.

(03:45):
Is that what you wanted?
I did.
Well, no, I have gotten the proposal of what I wanted.
Congress still has to pass it, and Biden still has to sign it for this to kind of go into
effect, but it could include two-year extension of the Medicare telehealth flexibilities,
meaning like being able to bill for care provided in the home or not being subjected to geographic

(04:10):
restrictions, two years of an extension on the first dollar coverage of high deductible
health plans, HSA tax provision, that's really important, a five-year extension for the acute
hospital care at home program, and lots of other things in it as well.
So, just super stoked to get these telehealth extensions.
Congrats, dude.
I mean, it sounds like you at least have the gears of the bureaucracy turning in our favor.

(04:34):
If it weren't for your Festivus wish, we'd be up a creek still without a paddle, especially
those folks living in the middle of the country where broadband access is a little bit less
reliable.
Yeah, I mean, that's my thing.
That's what I'm looking forward to for Festivus.
But what about you?
What do you want for Festivus?
You know, I feel like it's a little more selfish.
It's a little bit more me-focused.

(04:56):
I just want a digital twin.
You know, like, and I want one very specifically focused on managing the households and my kids.
And my self-care so I can continue to just like grow my cerebral capacity at work, right?

(05:17):
Which I really enjoy.
But like, you know, being a working mom is a grind.
And you know, being a working dad is a grind.
And you constantly feel like you're doing a little bit less in each arena.
So yeah, I just want a digital twin.
I don't know that that's really, maybe I just want like a clone of me or a humanoid.

(05:39):
Working along those lines that meets that underlying need of you're doing three jobs
at once.
Here's some relief.
It's just so depressing, isn't it?
I'm so sorry.
No, I think I think all of us could use like an extra hand in there.
I think it's I think I don't think that's selfish.
I think anybody, you know, if we could use technology in our personal lives to reduce

(06:05):
the burden of the mundane.
If somebody that was taken off of us, that would be great.
All right.
Well, now that we've reviewed our wish lists, I'm praying for yours, by the way, I feel
like that's going to benefit quite a few more individuals than just my digital twin.
I don't know.
I am pretty great though.
So I feel like you're having two of me.

(06:25):
It's going to benefit everybody in the long run.
JK, JK.
So let's get to the insights.
What have you been up to lately?
My nerdy companion from New Jersey.
Oh, so I just got back from Washington, DC.
I went to the ATA Edge Policy Conference, which is why I was, you know, the continuing

(06:50):
resolution was so top of mind for me, and which we were all waiting for with bated breath
when we were there.
And I love this conference.
It's a small intimate conference and it's entirely focused on policy and nerdy policy
at that, but it's with great people.
Wait, is there any cool policy?
It was, yeah, no, maybe not.

(07:16):
I don't know.
It is in my mind.
It's a good conference.
It's about doing good advocacy work with good people that are trying to make good things
happen.
So highly recommend ATA Edge.
But you know me and how much I love to hold like heady tech forward conversations in the

(07:37):
morning before I've had my coffee.
You know what that's like for me.
Yeah, that's why I don't call you in the morning.
So I got to spend a little bit of time doing a digital transformation focused special interest
group breakfast with some folks.
And we got to talk about data ownership and data liquidity in a time when there's this

(07:58):
market dominance of over where data is being stored in the EHR world.
There is an epic problem.
80% of Americans have a record in epic somewhere.
Epic has 51% of hospital beds under its sort of data generating purview.

(08:22):
And so what does that mean when one company is the vehicle by which people access healthcare
data in this country and who owns it?
Is it the provider?
Is it the patient?
And we had some really wonderful conversations around that.
It was one big topic.
And then the other big topic of our breakfast was around how do you identify standards and

(08:44):
guidelines and policy frameworks around around AI models that you're using in healthcare
to not just in terms of like certifying them to work, but what is the sustainability of
them?
How do you ensure that you're not letting your models drift over time and so that they're
not they lack efficacy into the future?

(09:06):
So there was some really wonderful conversations around that.
I'm gonna say I can I can hear O'Com all you faithful playing in the background as you
talk.
I'm saying choirs of angels, you know, I mean, like, yes, we need that.
And they just don't exist.
They don't exist yet.
They will.
Well, I feel like a lot of people are talking about them, but no one has implemented them,

(09:27):
right?
Or if they've been if they've been published in peer reviewed journals, no one's actually
showed that they work in practice.
Well, in this this particular conversation is focused on policy.
You know, here we're talking about, you know, from a macro level at the US government level,
how can we do to put that framework around these models that allow for innovation, but

(09:51):
also allow for the protection of patients and their data and the use of their data over
time.
So that was a lot of fun.
Then I got to spend some time talking to Salim Azhabi from the World Health Organization
on stage, talking about, you know, different policy frameworks globally, the work that they're

(10:11):
doing at the WHO for their global initiative on digital health.
We talked about, you know, how the US can really benefit from, you know, approaches
being taken in other countries.
There was this one gentleman with State Center from Connecticut.
I've never actually seen a policymaker be so articulate about artificial intelligence

(10:34):
and the risks associated with artificial intelligence.
I was really surprised.
His name was James Moroney, and I'm hoping we can get him on the pod sometime soon because
he was excellent.
Yeah, totally interested in meeting Jimbo.
That sounds great.
Jimbo.
What about you, though?
You've been busy, too.
Tell me more about what you've been up to.
I mean, I've been busy.
You know, like I submitted what I thought was going to be a poster for Mayo Clinic's

(11:00):
Automation Summit.
It was the first ever iteration of this annual event called VIBE.
Don't ask me what the acronym stands for.
I'm sure it means something super deep.
But essentially, I submitted a poster presentation on a couple of our automation initiatives,
and it turns out that it was much more than that.

(11:20):
They had some like an incredible exhibitor hall, 30 or so use cases from Mayo Clinic
on the automation side and some of our key vendor partners.
So it's really interesting.
It's like a showcase of like everything that's happening in the automation space, both on
the administrative business side and the clinical side at Mayo Clinic.
So that was super cool.

(11:41):
And of course, there were some great panels, wonderful discussion, you know, but honestly,
like a lot of it is like what we already know, what we've heard before, right?
Process improvement.
Don't automate a broken process.
What can we stop doing?
Now, I'm not saying we don't need to keep repeating that message for folks that haven't
heard it yet, but for me, I didn't necessarily get a lot of new information out of the panels,

(12:05):
although they were very articulate, very well executed.
What was really cool was to see highlighted on stage some of the premier examples of how
Mayo's been automating across their business.
So there was examples of course, the virtual nursing, the revenue cycle team won an award
for their coding automation.
HR won the People's Choice Award for personalized hiring experience for nurses, which was wicked

(12:31):
awesome.
And then the scheduling team also won an award for their smart itinerary creation for our
destination patients.
So really neat to see like all the innovation happening in that space.
And from a clinical practice side, our team was presenting on stage about the lung cancer
screening automation initiative that we've been working on in the community practice.

(12:54):
So super awesome summit, ended up being way more fun than I anticipated.
I didn't have any notion of what it was going to be like when we went there, but very cool.
Highly recommend folks attend in the future if they get the opportunity.
It's another one, like really cool conference.
I know.

(13:14):
I know.
We're like kind of conference junkies, you and I, right?
It's almost like we need some kind of digital tool to help us on our journey, something
like a digital twin.
OMG, that's exactly what I asked for for a festival is how I mean like, duh.
Well it's a good thing that that's what you're looking for because that's what today's show
is all about.

(13:35):
It's all about digital twins.
Coming up on the show today, we've got Dr. Lisa Shaw, the chief medical officer of Twin
Health focusing on using digital twin technology.
In support of reversing the ravages of metabolic diseases.
Really excited for that conversation.

(13:56):
But before we get into that, tell me millennial twin, what's coming up next?
Well, of course, my favorite part of the show other than our esteemed guests is the game.
We're going to twin it like Beckham and we're going to do a lightning round.
So stick around and we'll be explaining the game after a short break.

(14:25):
Are you a working mother navigating life in a corporate jungle that thinks work life balance
means attending well being seminars over your lunch break?
Are you skilled at keeping children under six alive, slaying budgets at the office and
at home, arbitrating disputes in the boardroom in the playroom, managing crises caused by
both collapsing servers and block towers?
Have you ever used a wet wipe for back of the napkin ideating?

(14:48):
Are you as good at dodging toys hurled by toddlers as you are dodging casual misogyny
by the water cooler?
Let's face it, you need help.
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(15:13):
Imagine a wing girl that walks, talks, thinks, snuggles, and smells just like you.
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Returning from the solo vacation that you've been putting off since you gave birth?
MamiClone neutralizes Slack messages that most certainly could have been avoided in

(15:35):
the first place, defends your calendar blocks like a child clinging to your hem when it
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to 100 plus messages from your school sent in the last 24 hours, and even plans your
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(15:58):
If you answered a Mami at home and bossed in the office, our digital twin technology
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(16:19):
The first 10,000 subscribers will be invited to beta test our gaslighter neutralizer prototype.
MamiClone, because two of you might finally be enough.

(16:42):
Welcome back to Tech To The Limit, folks.
It is time for us to try a new game.
And we are focused on digital twins here on the podcast today, and so Sarah has come
up with yet another amazing game.
So Sarah, what is Twin It Like Beckham, and how are we playing it, and what are the rules?

(17:05):
Okay, if by Sarah you meant chat GPT, then yes.
Thanks for the crowd.
I'll take it.
So Twin It Like Beckham is going to be more of a lightning round rather than us taking
turns.
So if any of you millennials ever watched Friends, there's a lightning round at the end of their
quiz game, and it's one of the best episodes of all time.
But I digress.
I'm going to essentially fire a series of identities at Elliott, and I'm going to describe

(17:30):
their digital twin and what they may be like.
And these are digital twins for famous figures throughout modern history.
And then Elliott is going to need to just rapid fire, tell me who he thinks it is.
Okay, and we're going to do the best to keep score.
All of our super fans know that we're really bad at simple math.
So bear with us.
It's not about who wins in the end.
Okay, says somebody who's only won one of our games ever.

(17:55):
But go ahead, keep going.
Oh my God, I think you meant this season.
Okay, thinking about this season.
And it was a pretty solid game to win because you dressed up like a certain bird that ends
up on a plate.
Anyway, we'll take turns to who wins the most points and the prize is eternal salvation.

(18:16):
So I'd say the stakes are pretty high.
The stakes have never been higher.
Speaking of that, I would like to quiz you first, Mr. Elliott, since I won.
Very well.
And I get to choose who goes first in the next great game.
Very well, very well.
Are you ready for this?
I am prepared.
Prepared, prepared.
Okay, my friend.
Go.

(18:37):
You ready for this?
Okay.
Yes, hit me.
His digital twin might help track wildlife migration in real time, optimize his documentary
schedule and ensure he gets enough sleep after long days narrating the wonders of the natural
world.
Who is?
Is it Richard Attenborough?
You're so close.

(18:58):
It's David Attenborough.
I'll give that one to you.
Richard Attenborough was the old guy from Jurassic Park.
That's hilarious.
Sir, David Attenborough.
All right, next.
I was going to say Steve Irwin, which should have been correct based off of that.
I would have been correct.
Okay.
All right.
Here we go.
This is the lightning round.
Okay.
It's not like slowly dripping water around.
Yes.

(19:18):
It's more of a circle, but go ahead.
I would prefer if he answered in the style of Jeopardy, like who is Sir David Attenborough?
His twin might have flagged early pancreatic health warnings, optimize his famously fruitarian
diet and suggested mindfulness breaks to keep him innovating longer.
Who is Steve Jobs?
William Salente, her digital twin might have monitored her stress levels, managed her training

(19:43):
recovery and advised her on physical health to keep her at the top of her game on and
off court.
Billie Jean King.
Okay.
You know what?
I'll give that to you too because it could have been any of these folks.
It was actually Serena Williams, but like when I read that description, you know what
I'm saying?
Like that's not super specific.
I'll take it.
I'll take it.
Take it, man.
Take it.

(20:04):
I'm feeling real generous this fastivist.
His twin might have analyzed his policy stress levels, Billie, policy, managed his basketball
recovery routines and provided real time decision making support during landmark health care
reforms.
This has got to be Barack Obama.
Muy bien.
Excelente.
That means very good, excellent for our listeners who aren't his fan of files.

(20:27):
Did you just translate muy bien?
You never know.
You never know.
Some people.
Okay.
That's not super worldly.
Next, her digital twin might analyze global climate data, provide her with more efficient
travel plans, and remind her to hydrate and rest between speeches and protests.

(20:49):
Speeches and protests.
Is this the kid, the Greta Thornberg?
I want to say, I'm going to say Thornberry from the Wild Thornberries, but it's Greta
Thornberg or something like that.
That's it.
It's Greta Thornberg.
Good job, Ed.
Good job, Ed.
It's Midwestern for a good job to see you know.
Her digital twin might have tracked her energy levels during ruling court cases, optimized

(21:14):
her body weight fitness routine, and helped her balance her legendary advocacy for justice
with her health needs.
Yeah, maybe it might have coached her to retire a little earlier.
Ruth Bader Ginsburg.
Muy bien.
Excelente.
Okay.
Her digital twin might have monitored her radiation exposure, lagged health risks from

(21:34):
her lab work, and ensured she took breaks from her groundbreaking research to care for
her stuff.
Marie Curie.
Okay, that's fantastic.
Great job.
Right.
Last two here.
His digital twin might have optimized his speech devices, monitored him.
Why are they all monitoring energy levels?
Come on.
Can we be more creative, chat DPD?
No, like by definition, it can't.

(21:56):
Fine, unless I ask it to.
His digital twin might have optimized his speech devices, monitored his energy levels, and simulated
communication strategies presenting his brow breaking ideas about the universe.
Stephen Hawking.
Oh my God, you're fantastic at this.
I mean, really good.
Okay.

(22:16):
Her twin might have monitored the health of jungle ecosystems, helped her balance conversation,
work with self-care, and even trapped Pimpanzi behavior trends over time.
Jane Goodall.
Well done, sir.
I wanted on the record that I was really lenient at least three times.
So I have a question.
I only counted nine.
You did 10?

(22:37):
Yeah, I thought I read 10.
Oh, you're right.
There's a space in my sheet.
Okay, let's go for another one.
Last one, you ready for this?
I'm ready.
I'm nine for nine right now, so this is amazing.
Bring the thunder, right?
This digital twin might have modeled pandemic outcomes, automated briefing preparations,
and ensure he stayed hydrated during endless media appearances.

(23:00):
Dr. Fauci.
Who is Dr. Fauci?
Who is Dr. Anthony Fauci?
Excellent.
If mine aren't as easy as this, you are going to pay.
10 for one pen.
You can't break this 10 for 10 when I gave you three of them.
Okay, okay, okay.
All right.
Are you ready?
All right, let's do this.

(23:20):
Question one, her twin might have tracked her energy during the civil rights protest, counted
her steps during bus boycotts, optimized her recovery routines, and flagged travel risks
for her during her legendary activism.
Rosa Parks.
Good job, Edge.
As you Midwestiners would say.

(23:40):
You're speaking my language.
That's so thoughtful.
That's very good.
Her twin might have optimized her recovery from chronic illness, monitored her diet during
expeditions, and suggested rest between her daring adventures in aviation history.
Unfortunately, it didn't come with GPS mapped data.
That's a million air heart.

(24:01):
Yes, very good.
Which is the easiest to have at each area ever.
I feel so good about myself.
Okay.
His twin may have monitored his recovery from war wounds, tracked his speeches for their
health reform impact, and simulated strategies to improve post war public health.
Too bad it didn't change his cigar habit.
Who is FDR?

(24:22):
Oh, very close.
You're on the wrong side of the Atlantic.
Oh, okay.
Who is Winston Churchill?
Yes.
Good job.
All right.
Question the fourth, his digital twin might have flagged warning signs for his mental
health, optimized his creative bursts and simulated experiments with new types of coils

(24:48):
to push science even further.
No word yet on whether it includes data from his Model 3.
Edison?
No, that's not right.
So close.
So close.
But like the fact that you said Edison makes this guy roll over in his grave.
Oh, okay.
I don't, I don't know.
That would be Nikola Tesla.

(25:09):
Yeah, yeah, yeah.
Okay.
Yeah, I wouldn't have gotten that.
All right.
Continuing on.
I guess I'm going to help internal damnation.
All right.
Her digital twin might have caught her early signs of tuberculosis, monitored her public
speaking energy and optimized her suffrage campaigns to reach even more supporters.

(25:32):
Yeah, that's really tough.
I don't know, but I know that the suffrage movement is thebomb.com.
I can't name any of the suffragettes off hand.
Can you?
I don't know.
She's on a coin.
Susan B. Anthony?
Yeah.
Yes.
Very good.
She's on a coin.
All right.
Lightning round indeed.
Okay.

(25:53):
This is a pity, Bo.
His digital twin may have tracked his innovations in microbiology, optimized his lab safety protocols,
and flagged early discoveries to prevent global pandemics.
It may also have tracked his daily milk intake.

(26:13):
Oh, yeah.
I know.
I don't know, but I know.
I feel like mine were way easier.
I don't know.
Tell me.
Louis Pasteur?
Oh, like I knew it was about pasteurization.
Hey, fun fact.
Did you know that Charlie Mayo, one of the founding brothers of Mayo Clinic, was the
first one to bring pasteurized milk to the Midwest?

(26:34):
The first doctor.
No.
How about that?
Yeah.
He was a farmer.
Cool.
I just think that's fantastic.
He was like big in public health, and it was like apparently a huge change management
problem for him.
Never ends.
Hey, real quick, real quick question for you.
What kind of milk is this?
It's pasteurized.
That's fantastic.

(26:55):
Okay.
Okay.
All right.
Her twin might have optimized her chronic pain management, tracked her painting posture,
and simulated color palettes to inspire even more of her iconic surreal self-portraits.
Frida Kahlo.
Who is Frida Kahlo?
She's my favorite painter.

(27:15):
Yes.
Okay, ready?
Yep.
I'm ready.
Her twin might have monitored her cognitive recovery after a brutal attack, optimized
her speech therapy, and tracked her efforts to change the narrative around women in education.
I feel like a horrible, like, feminist.
These are hard, Elliot.
I'm sorry.

(27:36):
I tried to make them, like, not hard.
I'm just, you know, this is my imposter syndrome, like, rearing against me.
I suppose a history major, god damn it.
Well, this is not, I wouldn't describe her as being a part of history, unless we all
consider ourselves living through history right now.
Okay, I don't know.
Rural attack.

(27:57):
Malala Yusofzai.
Yusofzai.
You didn't mention anything about education.
Literally, the narrative around women in education.
You didn't hear that?
You can have an understand what a help.
I mean, I was thinking the U.S., right?
Like, I'm like, who got attacked for educating education in the U.S., you know?
I mean, come on.
Teachers.
True.

(28:17):
Okay.
Her digital twin might have monitored stress levels during groundbreaking moments in diplomacy,
managed her recovery after tense negotiations, and tracked her health while serving as the
first female U.S. Secretary of State.
Condoleezza Rice.
Madeline Albright.
What?

(28:38):
Madeline Albright?
She was the first U.S., female U.S. Secretary of State.
No way.
No, Madeline Albright was British.
There's no requirement than to be U.S. Secretary of State.
What?
Were you being kidding me?
Only the president has a constitutional requirement to be a U.S. citizen, or a born U.S. citizen.

(28:59):
This can't get any worse.
Sorry.
Okay.
Whatever.
Keep going.
What am I embarrassed for me?
Her twin might have monitored her energy levels during long days in the jungle, optimized
her observation skills, and tracked groundbreaking data as she transformed our understanding
of chimpanzees and conservation.

(29:19):
Thanks for that, Pettie vote.
James et al.
Yes.
Okay.
Madeline Albright was the first U.S. Secretary of State.
I am such a horrible history major.
No.
I might offend some of the United Latin America.
Her digital twin might have optimized her reflexes on the tennis court, tracked her

(29:39):
mental stamina during historic matches, and simulated strategies to fight for equal pay
and gender equality in sports.
Who's Billie Jean King?
Nailed it.
That's why you guessed her last time.
It totally is.
Thanks.
Okay.
Last one.
His digital twin might have optimized his energy.

(30:02):
Optimizing energy, man.
It's all about optimizing your energy.
For filming endless science experiments, tracked his CO2 admissions to champion climate action
and simulate engagement scores for his science-based educational content.
Dr. Stowe.
Bill Nye, the science guy.
Oh, God.
You know what?
I'm tired.

(30:23):
I don't think that you thought you were going to lose that badly.
I'm bitter.
Can we move on?
I would be too if I just lost internal salvation by eight points.
First of all, I don't think it was a level playing field.
Let's move on.
I'm ready to just die.

(30:44):
Wow.
Sarah, I am so glad that I have won eternal salvation by winning this game with you.
I got that going for me.
Can you bring me with me as your digital twin or just be fraternal twins?
Well, I don't.
No, just analog.
I can only bring an analog twin, unfortunately.

(31:07):
Okay.
I wouldn't brought you.
Thank you.
Thank you for that hypothetical.
Anyway, listeners, thanks so much for playing along at home.
How many did you get?
Let us know on LinkedIn.
We look forward to seeing you on the other side of our commercial break.

(31:27):
Stick around to hear our conversation with Dr. Lisa Shaw.
We'll be right back.
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(34:06):
Welcome back to TechIt to the limit, everybody.
We are so excited to have with us Lisa Shaw in the matrix of healthcare.
Dr. Lisa Shaw is Trinity, soaring over systemic barriers at top speed on her motorcycle, no
doubt.
Dodging innovation stifling bullets so fast, even Morpheus would be impressed, and using
Twin Health's whole-body digital twin to rewrite the rules of type 2 diabetes care.

(34:32):
As chief medical officer, she blends clinical precision with bold techno-prisoners innovation,
building her expertise like a roundhouse kick landed perfectly on Agent Smith's jaw.
Armed with a bombing floor-length leather jacket, twin glocks, a red pill in degrees
from Duke, UMDNJ, and the University of Chicago, Dr. Shaw is rewriting healthcare source code.

(34:56):
A mom of three, an award-winning leader, she's proving that the future of medicine is as
dynamic as we want to make it.
Welcome Dr. Shaw.
May I call you Lisa?
Yes, please, and thank you, Elliot and Sarah.
So great to be with you today.
It is wonderful to have you here.
All matrix jokes aside, we like to start, technically, with puns as our jokes, really.

(35:22):
So we like puns, we like play on words, and we ask all of our guests, be they dads or
be they not, what is your favorite dad joke that you'd like to share with us today?
Oh, I love that.
I live in a house where dad jokes are in books.
It's like our favorite Father's Day gift for my partner.
But I'll tell you, there are two I really like, and it's because I'm a healthcare geek.

(35:47):
So can I share two with you?
By all means, please do.
Okay, awesome.
So the first one is, did you hear about the guy who drank invisible ink?
He's still at the hospital waiting to be seen.
Nice.
I love that.
That's so good.

(36:07):
Definitely didn't see that punchline coming.
I love a second helping of dad jokes, please, Lisa.
Yes, indeed.
Okay, the second one, and you may not get it if you didn't ace chemistry, but I was
going to tell you a sodium joke, but then I thought, nah.

(36:28):
I love it.
I love, love, love it.
Okay, I did take chemistry in high school, but yeah.
What are you, wait, I'm sorry, so Lisa, what do you do with a dead chemist?
You bury him.
I'm going to write that.
I got to write that.
I got to add that to the film.

(36:50):
Rarely can someone follow up my chemistry joke with their own chemistry joke.
I'm impressed.
Anytime.
Wow.
Lisa, let's dive into some of the serious questions.
Will you tell us a little bit about TwinHealth and what should our listeners know about your
company?
Yeah, great.

(37:10):
Excellent.
So TwinHealth was founded in 2018, really with our purpose being to create the first
metabolic digital twin.
So what is that?
Well, it's really a personal health companion that helps people heal the root cause of chronic
metabolic diseases.
Think of pre-diabetes, type 2 diabetes, and unhealthy weight obesity, and so forth.

(37:34):
And when Twin invented the digital twin, we were really thinking about, and you have
to know a little bit about digital twin technology, which I'll get to in a second, but really
we wanted to empower people to take control of those chronic conditions and be able to
figure out how to heal their own unique and precise metabolism.
So the digital twin, partnered with a member's dedicated care team, is a real-time dynamic

(37:59):
model of everything happening inside an individual's body that drives their metabolic health.
And it really provides a window into a person's body and gives people small little actions
they can do in their everyday life to impact their health that is precise to them and their
biology.
We don't only take into account one's biology, but we also incorporate into the digital twin

(38:23):
technology preferences, behaviors, and choices that people make.
And together all of this is able to really help people uniquely figure out what matters
most for them and ultimately heal and really reverse or take away these chronic conditions.
That's incredible.
This is like hyper-individualized, precise medicine.

(38:48):
Very, very excited.
I wish that public education could be this personalized, but any kind of personalization
in any industry like this is really powerful.
So that's so exciting.
And I loved hearing you say that you really want to empower people to take control of the
cause of their chronic conditions and do so in a way that aligns with their personal preferences

(39:14):
and their value system.
So even going beyond the genetic code, right?
That is so cool.
Thank you for sharing that.
Elliot, do you have a follow-up?
Yeah, I did.
I wanted to ask.
So can we unpack a little bit this concept of the digital twin?
It's a buzzword that we hear a lot.
And basically, if I'm thinking about it, I'm thinking I have massive data that I have generated

(39:36):
in some way, shape, or form, that is compiled, analyzed, and organized in such a way that
it is a mimicry of me, of my reality, of my physical, corporeal body, right?
In terms of data that I can then play with and make changes to and then model out the

(39:58):
outcome of and then make those suggestions back to me as the user.
My question, so if I got any of that wrong, please let me know.
But my question to you is, how do you create a digital twin for your consumers, for your
clients?
I love it.
I love it.
And very impressed with your understanding of digital twins, Elliot.

(40:20):
And I love, Sarah, that you said education, right?
Because we actually use digital twin technology today in some very common industries and use
cases, right?
Self-driving cars, airplanes, use them.
And the idea, and I think it's important, just kind of go through a more common example
before I talk about the human metabolism, which is actually a little more complex, believe
it or not, than rocket ship.

(40:41):
No, surely not.
No.
So, you mean the human metabolic systems?
No, that's not complex.
So simple.
So simple.
You know, definitely physiology and gross anatomy were my easiest classes in medical
school.
Just kidding.
Yeah, so when you think about airplanes, it's a great example.
An airplane flies every day, millions of them, right?

(41:01):
And they have sensors, both inside and outside the plane, that can really say for that particular
plane, no two environments are going to be exactly the same.
The weather, even the pilot, and what's happening inside the plane.
So you can imagine all of these different things that can impact that flight.
Sensor technology is able to learn from every flight out there and to continue to improve

(41:23):
and predict, essentially, what a given situation or environmental input from the sensors is
going to do to the outputs or what's going to happen to the airplane.
It's very similar with human metabolism.
So what we did is we use that same concept.
And if you think about the sensors that we put on humans, we use wearable sensor technology

(41:46):
that is approved and being used in healthcare today.
So the key sensors we use for the conditions that I spoke about earlier are four in particular
that are really important.
The first one is a continuous glucose monitor.
So we do use those.
So those are not finger sticking, right?
They're worn on the arm and they can measure a blood glucose every few minutes.

(42:08):
And so you can imagine without finger sticking yourself, you're getting a real time reading
of blood glucose.
So this is a huge innovation in healthcare and something that we've progressed a lot
in the recent years.
The second sensor is an activity tracker.
Think about this as the risk trackers that many of us are wearing today.
And a lot of us use them to not just look at the time, but also our steps, for instance.

(42:32):
So they can do a lot more than that.
And the ones we use are really focused also on sleep.
Sleep is a huge driver of metabolic health.
How well you sleep, how many hours and the quality of that sleep.
These trackers have become more and more sophisticated and ours is used for looking
at sleep as well as heart rate fluctuations and changes, activity, respiratory rate and

(42:57):
stress.
We can model out stress.
And you can imagine you have blood glucose in combination with all of those data points.
Our third sensor is a body scale we use.
It's an impedance scale.
So we can look, obviously we care about what our weights are when we stand on the scale.
But as you think about metabolic health, it's a lot less about that number and much more
about the composition of those pounds.

(43:20):
So what is your muscle mass?
Visceral fat, the fat unhealthy fat around our organs, water weight, scale to muscle mass,
et cetera.
So we can look at all of those components and make sure we're moving the right ones.
And then finally, we use a Bluetooth blood pressure cuff to monitor blood pressure.
Wow.

(43:40):
That sounds like a Christmas wish list in the making.
At least for Elliot and I, we want to put on all these wearable technologies and see
how they work.
Oh yeah, do you want to pivot to the next question?
I do, but I have one more question about this.
I'm sorry.
I'm sorry.
We're talking about, so you've got your activity tracker and your continuous glucose monitors,

(44:03):
which are providing you thousands of data points over and over and over again.
And then you have your body scale, which is probably giving you about once a day, maybe
twice for people that like to do it morning and night.
And then you've got your Bluetooth blood pressure cuff, which you maybe are getting
once a day.
If you had your druthers, what data points would you want to be pulling in a continuous

(44:25):
way that you're currently unable to do in a continuous way that you can only do intermittently?
Yeah.
Yeah.
So I would say the glucose, I would love to see it continuously.
And I'll tell you something else.
There's more to the data we get.
So we get, I want to expand a little bit and then I'll get to your question.

(44:45):
So we get about 3,000 data points a day, okay, and our numbers.
This is pretty significant when you think about that.
And obviously the activity tracker is more continuous, right?
You can see heart rate continuously, steps and so forth.
Sleep as long as they're wearing the activity tracker, you bring up a great point about
the scale and blood pressure cuff because there's also a little bit more of, not everyone

(45:06):
wants to stand on the scale.
So you really have to get a minimum amount in some cases.
What do you need actually?
And once a week is what we need minimally because it can be a very negative experience
to stand on a scale for many people.
And you know.
I speak to that.
I can speak to that.
You know, it is a daily ritual and self-loathing.

(45:27):
It's nice.
I'm apologizing for a lot of people.
And we are first and foremost about everything we talk about today about healthcare is really
about how do you motivate people to sustain and keep with it?
And we know for twin, we need the data.

(45:47):
We need that data.
So we have to make the experience of wearing a CGM and an activity tracker a positive one.
If we make you or force somebody to stand on a scale every day, they'll just stop all
together and they will lose trust, right?
So a big part of this is about how do you help people with their own paradigm of behavior
change, right?

(46:07):
Which is really, really important.
So the other data we get from people is what they tell us, which is, you know, what they
ate, how they're feeling, and frankly, the conditions or limitations of their lifestyle.
So for instance, you know, I'm not going to cook, so don't ask me to cook, right?

(46:28):
Or I'm not going to go outside and walk because I don't live in a safe neighborhood at night.
So it's not really a place I can go outside and take walks.
And so all of this has to also be incorporated into twin if really what we're talking about
in the case of metabolic dysfunction is lifestyle changes, right, and making changes.
Yes.
I just want to just recognize how pivotal that is that you're living and walking through

(46:55):
the steps of your patients in this journey.
And listening to you speak about this technology and the way your company is approaching it
is, okay, let's get inside our patients shoes here and understand what matters most to them
and how this experience is going to impact their health overall.
It's not just, okay, give us all the data points and then we'll tell you what you got

(47:17):
to do, right?
I mean, even right down to that, okay, stepping on a scale can be a traumatic experience,
you know, for any individual.
So thank you.
I think that that is critical and sets you apart from many other technologies and companies
that are in this space right now.
Yes.
Thank you.

(47:37):
Thank you, so when you ask me back to, you know, Elliott's question, what do you wish
you could get continuously?
I obviously do want things like blood glucose and I would really love to see some of the
things that we get in blood work.
We also take quarterly blood work on all our members.
So we actually measure and calculate insulin resistance.
This is something people don't talk about enough, but it's actually really the fundamental

(48:00):
root cause of what drives metabolic dysfunction or poor metabolic health.
So everything starts with insulin resistance, which you can't see it happening, right?
The inflammation that's happening in your body, the insulin resistance that's happening
in your body and the deposition of fat into places we all wish they wouldn't go, but mostly,
you know, the belly organs and the abdominal organs and all of that happens before these

(48:23):
diseases where they're ugly heads.
So what I really wish is, could we get into that?
I mean, could I get insulin resistance regularly on someone?
Could I understand their inflammatory pathways real time?
That would be absolutely fine, but we're just not, we're not there yet.
Could I get the way a person thinks about behavior change continuously?

(48:44):
What's happening inside their heads?
What are they willing to do or not willing to do?
I would love to have that continuously.
We can't, right?
So what we do make the best out of what we have, we get what we get continuously and
as real time as possible.
And then we can recommend to people, to individuals, do this.
But what you need to really understand is what are they willing to do and what are they

(49:05):
not willing to do?
And we've been able to somewhat gamify that experience in our app to actually learn when
we make a recommendation to them, are they willing to try it?
And if they're not willing to try it, then we have to surface something else because
if there's no choice, then it no longer, they have accountability over their own health

(49:27):
care.
Yeah, that's fantastic.
I'm just going to repeat that for the folks at home.
If they don't feel like they have a choice, they won't feel accountable to their health.
That is something that you learn as a parent very early on.
Very quickly.
Yep, do you want the red plate or the blue plate?

(49:47):
It's a good thing I had children because being a doctor at Twin Health has been really about
the same lessons.
I love it.
I bet, I bet, I bet.
So Lisa, so when it, when I don't have a lot of personal experience with diabetes, but
when it comes to type two, two diabetes, right, this is that this is an ongoing chronic metabolic

(50:10):
disease.
And people really think about it mostly in terms of management.
How do I manage this chronic disease?
But that's not what Twin Health is about.
Twin Health, you're about undoing some of the damage that has wreaked havoc on a person
due to their metabolic disease, due to having diabetes.

(50:31):
And I don't want to use the word reversal, but, you know, kind of rolling back the clock
a little bit to put them into a better place of management in the future.
So how do you convince people that have heard this message over and over and over again
that they've got to just manage their diabetes, that something like that where they can undo
that damage is possible?

(50:52):
Number one, and then what's the risk if they don't achieve that outcome to the patients,
to their lifestyle, to their psyche?
That's a great question.
So first, let's talk about this idea of how we can undo the disruption.
So historically, if you think about type two diabetes, I think if you ask most people,

(51:13):
they, some would say it's, you know, genetic, and that's true.
There's a genetic component for sure.
Many would say it comes with unhealthy lifestyle and gaining weight, and those are all truths.
And to date, our mainstay of management, and I love that you use that word, because this
has truly been what my career has been about is management until twin health, where we

(51:36):
really have an opportunity to do something different than disease management.
What we mean by management and what is in our arsenal as a physician is really medications,
right?
That's in, that's our arsenal.
And of course, and, and, you know, I am by no means not a believer in medicines.
I think they're really important, and they absolutely have transformed what has happened

(51:58):
to people with type two diabetes, maybe advent of insulin type one and type two, right, has
completely changed the outcomes people would have had, as well as other drugs that we're
seeing, you know, grow in the marketplace, especially recently, including those the GLP
ones.
What I'll say is different about twin is, when you think about disease management, and you

(52:18):
think about the actual etiology of type two diabetes and what's happening, is there are
disruptors to the metabolism that come not from necessarily just your genetics, but
these external factors like your diet, sedentary lifestyle, stress, poor sleep, and over time,

(52:39):
all of these things create insulin resistance inside the body.
They create this chain where your body actually changes at the surface of your cells.
There is a disruption in the processes, metabolic processes, so that you can no longer actually
recognize a hormone like insulin that your body naturally produces.
You can no longer have the same response to it.

(53:00):
And when glucose in our body doesn't get turned into energy, like when we're kids and we eat,
you know, a big bowl of pasta and then go run off and play soccer, no problem, right?
But when it doesn't, we eat that big bowl of pasta and then we sit down back at our
desk or we go to sleep immediately.
What ends up happening is it turns into fat.
Glucose can only have two pathways.
Now all of those pathways that are happening in the body just get damaged over time.

(53:24):
What happens then is we give you medicine and then a year later they continue to get
damaged because you're not changing your lifestyle.
The medicine is managing a number.
It's finding other ways to get that glucose out of your body, but it's not actually fixing
your body's ability to utilize that glucose for energy.
Does that make sense, you know, at that point?
Yeah, yeah.
Right?

(53:44):
So what ends up happening is everybody has explained diabetes better to me in my entire
life.
I love it.
Thank you.
I do do this a lot, so maybe that's why.
But I have to simplify this for our members, our patients, because to your point, how am
I going to convince them?
So what happens is every time you go back to the doctor, the doctor will say to you,
all good physicians do this in their 10 minutes that we get with you, is you need to exercise

(54:07):
more, you need to eat better, you need to stress less, and you need to sleep more.
Well, I don't know about you guys, but yeah, good luck, right?
And so we've seen things like keto diets.
We've seen things like excessive exercise plans and lots of things that people have
tried and sleep gadgets and all of these things.
And sure, but they're not very sustainable because the advice themselves is still very

(54:30):
generic.
So giving up every carb is a really different thing than finding out rice and bread have
a completely different response in your body, right?
So this is a very difficult thing to execute on.
So what the provider or physician will do is say, well, I got to add a little more med
because we got your A1C down, but now it's right back up.
And so what you see happen is it's just more and more medication to maintain this baseline,

(54:57):
but we're not actually fixing the body and what's happening inside.
Twin basically breaks that cycle.
It comes in and it says, this is exactly what is driving your metabolism to slow down.
It's the rice.
It's the 3,000 steps a day rather than five.
It's the four and a half hours of sleep you're averaging a night.

(55:20):
It's your stressful job where you're sitting at a desk all the time.
It's the fact that you don't have a fiber in your diet.
They can look at these very small micro opportunities, if you will, give you some recommendations
that allow you to literally go back, make these small choices and adapt them, and then see
the need for medication throw away while your A1C comes down.

(55:44):
That is a huge reward for people because what you used to is something very different.
Yeah, I so appreciate that you're sharing this from a patient lens, which is like, how
disheartening if I'm doing what I am prescribed by my doctor, if I'm putting in the effort
and I still don't feel like I'm making a dent in my health, that's just got to be so disheartening.

(56:11):
And then on the flip side with twin health, you describe them as micro opportunities,
right?
So, what that reveals, like the root cause and where do I as a patient want to choose
an area to focus on for improvement that's actually going to help me heal, right?
Rather than I'm just pushing a boulder up a hill and it's going to roll back down in

(56:33):
six months, right?
I am kind of curious around this idea of, okay, once you've identified these micro opportunities
with patients, what's the behavioral activation component, right?
Like, how does twin health play a role in helping them with that behavior change?
Because even folks without chronic disease know that behavior change is one of the most

(56:57):
difficult things to do ever, right?
Oh, it's so difficult.
This is, I think, where we really excel.
A lot of people can utilize a continuous glucose monitor and make observations and say, okay,
well, maybe I should eat less of this or more of that.
Right?
We can, I mean, anyone could theoretically do that.

(57:19):
What we figured out is that how you're willing to change your behavior has to do with the
things that matter to you.
So for instance, we don't lead with diabetes or obesity.
What we ask a member when they first join twin is we ask them what their goals are, okay?
And we define goals as three types of goals.

(57:40):
Health goals, personal goals, okay, and then what we call sort of financially inclined goals.
So like the co-pays, the expenses of healthcare, right?
But really around like, where is it that you wish you could save more money on your healthcare?
Because we think this is actually a really important thing for people.
The co-pays around some medications make them not use them.

(58:03):
Make them actually choose to use them less frequently.
And if you don't take your medication, you can come in on a lot of medication and be
uncontrolled because you're worried about the cost.
And let's face it, the cost of healthcare is a lot on the member.
It's not just on society.
It's on the patient themselves.
So when we talk to people, the first thing we ask them is like, what are your personal
goals?

(58:24):
And what is amazing for me is that people's personal goals are really actually very vast
and not really having to do with their diabetes.
Very few people say, you know, I want to be without diabetes.
What most people will say is I want to live and watch my grandchildren get older.

(58:45):
I want to be able to hike like I used to when I was 25.
I want to be able to play soccer again.
Then we ask them about their health goals.
And the number one health goal that I hear from people is I want to be able to not take
medication.
And the second one is I want to lose weight.
But I don't ever hear people say, I want my A1C below 6.5.

(59:07):
I'll be honest, I don't think that's how they're thinking about it.
So we know that you can lose weight and take less medication if we can get your A1C down.
We know on the twin side, that's the first thing we have to do.
But we don't need to tell you that.
When we work with you, we're taking your goals and we're celebrating every achievement.
So if you're a blood glucose, let's say you want to lose 10 pounds.

(59:30):
If your blood glucose comes down by 10 points on average, we know that you're that much
closer to 10 pound loss.
And we use that as real time data to say, look, your average blood glucose has now come
down to this, which translates into you are on the road to losing this much weight in
this much time, which then we can corroborate with, by the way, you're already down three

(59:52):
pounds.
And that's only in seven days and so forth.
And so we're using their own desires and needs.
And a lot of people will say, I just want more energy.
I want to film.
So we'll get inputs from people on their energy levels and use that to reach back out to them
and say, congrats, your energy level just improved.
And they'll bless this, right?

(01:00:13):
So that's one piece.
The second piece, I think that we've really understood in behavior change is it's much
more about not what people are willing to do, but what they're not willing to do.
And if you can really understand what someone's not willing to do, and this is the secret,
I think in healthcare, we just haven't been able to figure out yet.
You know, as a physician, we'll say, man, you know, that person is just so nonadherent.

(01:00:36):
They never take their medicine.
That's like a four letter word in my vocabulary, right?
That along with noncompliance.
I can't, I can't even, I can't stand it.
Just, it's crazy because the reality is we haven't really sought to understand why taking
that medication isn't in their book of values.
And I think that's really important for us.
And what I'm seeing at Twin is we have the opportunity to say, okay, what aren't you,

(01:01:00):
name three foods you're never willing to give up.
That's a big conversation.
Then here are the foods I want you to eat.
Name the one, you know, exercise that you really don't enjoy.
Tell me the one thing in your family culture and traditions that's really important to
you, bowling on a Saturday night.
I've gotten that answer.

(01:01:21):
League.
Okay.
So on a bowling league night, you're going to eat your chicken wings and I get it and
you're going to eat your pizza and we're not going to tell you not to because that's so
important to your ethos.
But if you knew that Monday through Friday, you could do X and Saturday, you could do
that Y, it changes how you think about your own health.
So that's really, I think what we've mastered is understanding what people are not willing

(01:01:44):
to do and tying back all of the things that they choose to do to immediate achievements
and rewards that align with their initial goals.
I wish this interview were two hours long.
It's just so awesome.
I will say though that, you know, what you were just kind of describing, I'm just going
to go back to my, I just see everything in the world of being a parent and that small

(01:02:09):
reinforcement and celebration of success of those small things is such a need for parents
to give their kids as their kids are learning.
I mean, it's, I mean, so it just goes to show that you don't really change how you learn
and how you grow as a person as you get older.
So anyway, that really just resonated with me.

(01:02:31):
It's something that's complicated as your health.
Absolutely.
It's just, it's, and it's something that you just need to be able to own.
And so teach me how to be able to do that.
Yeah.
For sure.
So what's next, what else is there for digital twin technology outside of diabetes?

(01:02:54):
What, where is, where is twin thinking about applying the same kinds of technologies to
improve others' health?
Yeah.
Well, it's a great question, Elia.
I think for us right now, we just, we feel like we have such a big opportunity just in
these chronic metabolic diseases.
They impact so many people, you know, across the world globally, and they're getting worse.

(01:03:18):
One area that we've been really deeply seeing the impact of our digital twin technology
is it used to formally be called non-alcoholic fatty liver disease.
Now it's a metabolic associated liver disease where it's this fat deposition in the liver
that creates ultimately liver cirrhosis and liver transplant.
It's actually the number one cause, believe it or not, of liver transplant right now in

(01:03:41):
the United States.
It's, you know, long exceeded other, you know, things like hepatitis and alcoholism.
And what we're seeing is that it's extremely expensive, right?
A liver transplant is extremely expensive and there are lots of drugs coming out now
that are going to have a very hefty tag on them and have a lot of side effects and a
lot of challenges that we're excited to see.

(01:04:02):
We're actually reversing and improving and we have a clinical trial, a randomized control
trial that we've been doing with the Cleveland Clinic that just completed and we studied
the impact on liver disease in that trial as well.
So we're very excited about the results of that and I think that's going to be an opportunity
for us as it becomes a bigger issue in America in particular for us to continue to work on.

(01:04:23):
I think the other areas that we're seeing great impact and, you know, we don't have per se
a solution today but we see this in our current members is inflammation.
So obviously the inflammation of cardiovascular disease is very obvious, right?
Because by reversing these other conditions and the damage, you fix a lot of the cardiac
risk.
But think other inflammatory illnesses, things like, you know, neurological diseases or even

(01:04:49):
rheumatological diseases, thyroid.
I think there's a lot of other opportunities that we would love to continue to expand on.
But for now, we feel like we've bitten off a bold audacious goal with these conditions
and we're going to continue to focus on them for the millions of people affected.
Well, like you said, there's plenty to do.

(01:05:10):
So I'm wondering if you could help dive into a little bit more about the technology itself,
right?
Because, you know, at the core of what you're doing is behavioral change based off of massive
amounts of data.
So can you talk to us a little bit about the types of models that you use to, obviously,

(01:05:30):
we don't want to look under the hood and we don't want you, we're not asking you to
open up your GitHub for us.
But conceptually, what are the kinds of models that y'all have used to put these twins together?
Sure.
So we are using deep machine learning algorithms, mathematical modeling, and artificial intelligence,

(01:05:52):
right?
So what, if you think about how that works, is every twin learns off of another twin.
So when a member joins, we have data from thousands and thousands of twins and the machine learning
algorithms are processing that data real time and matching them to another member who's
their closest in the cloud, if you will, their bootstrap sort of starting point.

(01:06:16):
Then from there, it learns from that.
It's localized training.
It's localized training to the individual.
It's a very scalable model.
That's awesome.
Keep going.
And then it continues to learn and the more data we get with people with common disease
states or common chronic metabolic diseases, the more we can learn.
And it's also looking at things like what's your ethnicity, what state do you live in,

(01:06:41):
what's your zip code, what's your race, because then you can also incorporate those aspects
into the model.
And it can learn from people who look like you both clinically as well as non-clinically.
And so over time, it continues to learn so the more twins we add, the more the models
get richer and smarter.
We continue to add more inputs constantly so that we can make the model that much smarter

(01:07:03):
on all of these different, what I'd call inputs.
So what we've learned very quickly is it's not just nutrition, the power of sleep.
And we learn that from really taking nutrition and expanding and looking at sleep.
So those are the models we use.
Now, AI has come so far that we can use artificial intelligence and these machine learning models

(01:07:26):
in even more incredible ways now, even just in how we think about empathic engagement with
members, preferences, how they respond, what tone they're going to respond to.
So we've really been able to expand there as well, which I think helps with the behavioral
change.
I'm wondering if you're even pulling in metadata around the gamification points.

(01:07:48):
So thinking about how quickly are you responding to the question or to the prompt that you
are providing the member?
Does that have any kind of correlation into behavioral change in and of itself?
Absolutely.
Or do you respond on weekends and evenings?
Do you respond during the week or week?
Is it you have a real challenge when it comes to dinner time?

(01:08:10):
And frankly, also just how many times a day do you open the app?
Where do you go?
Where do you engage?
What's your first view?
We look at all of that and it's been pretty powerful to see the impact of those types of
behaviors as well.
Are you incorporating SDOH data?
Yeah.
So in the traditional term of it, yes, we are.
We use a lot of it we get from our partners through our data of member demographics.

(01:08:37):
And then of course we ask members questions.
So we try to incorporate our own self-reported data on things like, do I am a single parent
of five children and I work a full-time job?
And to all the way to I can only spend $50 a week on food to my closest grocery store
where I do all my shopping is all to your Walmart.

(01:08:58):
So we're looking at all of that and really trying to bring that in as well.
And where people shop is a really nice way to also link twins, right?
Because now you can understand.
What am I going to purchase here?
What are people eating here and how do we understand the impact of that?
Thank you for talking about some of those correlates outside of the like the biological

(01:09:19):
like, you know, genetic data, right?
Because that's so important for many people.
You know, behavior chains isn't just about behavioral activation.
It's about what other barriers are getting in the way of their goals.
You know, it could be financial, it could be stress related because they are a single
parent working two jobs.
It could be that school is closed and all they have energy for is making some mac and

(01:09:43):
cheese, right?
And as you mentioned, it could be that they don't have a grocery store in their zip code
and it's not safe to walk at night, right?
So how are you going to get exercise when you're choosing between a membership at the
Y and your medication?
So I just I really appreciate that you're taking into account that every patient's living

(01:10:03):
situation is different.
It's unique.
Yeah.
And I, yes, and I would say, Sarah, I think it's a really important part of why we chose
for our partners to be, you know, self-insured employers and payers or health plans because
direct to consumer was something like this is a very different population that you're
accessing, right?
And I, we really wanted to have impact on greater America where people are really struggling.

(01:10:29):
And I'd say the majority of our members are living, you know, we cover over 40 states
now and the majority of our members are living in very rural areas where they have, you know,
low access and we talk about access in healthcare, but access in life is just a totally different
fundamental issue.
So, Lisa, you mentioned 40 states.
Do you know off the top of your head how many members you have enrolled across the United

(01:10:54):
States?
Yes, we are over 10,000 now.
Wow.
Okay.
Any international presence for you all?
Yes, actually, we are in India as well.
Okay.
Yes.
Well, Lisa, this has just been amazing.
I really enjoyed this conversation.
I have one final question for you.

(01:11:15):
As a mom of three, you're also a practicing physician and a chief medical officer at Twin
Health.
How do you prevent or reverse maybe burnout for yourself as an individual?
Can you tell our listeners kind of what are some of your self-preservation, self-care,
self-compassion strategies?
And it's unlikely, but I want to ask, do you have a digital twin that handles your email

(01:11:40):
and Zoom calls on your behalf?
I wish.
Little do you know, she's our synthetic guest right now.
Our first synthetic guest.
I'm not really here.
I actually, that is the one thing I've been asking for.
I do have a digital twin, but that's not what they do.
I love it.
You know, I will say I've been, you know, a mom and a professional for many, many years,

(01:12:03):
I hope, you know, 19 to be exact.
And I have three kids and I have found that twin is the first time where I actually am
super in touch with when I can't do it all and when I need to slow down to speed up.
And what I found is, you know, for me, exercise is really important.

(01:12:24):
And the interesting thing for me is that it's actually healthier for me to do at night, but
that comes at a cost of time with my kids because that's when I'm with them.
So I make a choice to do it in the morning.
And I know it's not better for me.
My twin tells me it's better for me to do it in the evening, but I need to do it in
the morning because I can't miss out on time with them.

(01:12:44):
And what it does for me is it says, well, then you got to do some other things because
that alone is not going to work for you.
So I really learned to adjust my eating, but also set a really good example for our kids.
We, we, both my husband and I have a twin.
We eat at very twin friendly dinners, but we also know how to eat the things we love in

(01:13:06):
moderation and our kids eat like that too.
And so I really think this has just been a great opportunity for us to set good examples
for them.
But my exercise is critical.
I work out, I do something every single morning.
It makes me a much, much better mother and a much, much better colleague.
So I really, and a better physician for my, for my members.

(01:13:26):
So that's my secret, but I don't deprive myself of life.
I do enjoy my life.
That's lovely.
So many good nuggets in that last response.
Thank you, Lisa.
It reminds me of me.
So I have a, my husband and I have an uncompromising, we are uncompromising in, in dinner as a

(01:13:47):
family every night.
Every night.
It's so important to us.
And then, and I applaud you for doing everything that you are doing and still making that happen.
So kudos.
Got to do it, right?
No chicken nuggets for you and fancy food for me.
We're all eating chicken nuggets if that's what we're eating.
That's right.

(01:14:07):
That's right.
And nothing else.
Like we're, no, you can't have.
No, you may not have a full cereal later.
Exactly.
Exactly.
Oh my gosh.
That's so true.
Lisa, thank you so much for joining us here on Tech at the Limit.
Something to us about digital twin technologies and twin health.
It has been a blast to have you on.

(01:14:27):
Where can people find you and find twin health online?
Yes, twin health.com online is our website.
And then I'm on LinkedIn and so reach out at any time.
And we also have an Instagram presence as well.
So it can follow twin health.
Awesome.

(01:14:47):
Thank you so much and I wish you all the best heading into the holiday season.
Thank you.
Thank you both so much.
It was great to have you here.
Thank you.
Have a great one.
Bye bye.
And there's the awkward pause.

(01:15:13):
Welcome back to Tech at the Limit listeners from that fantastic conversation.
I'm with Dr. Shaw.
Lisa was just amazing.
I just loved having that breezy conversation with her.
She was so easy to talk to.
So Sarah, I don't know about you.
I'm feeling a little peckish.
I could go for some nuggets.

(01:15:35):
Do you have any kind of wise nuggets that you can share with me?
I have a whole bucket.
But it only has two like giant nuggets in it.
Kind of like the shredded wheat from Europe.
It just seems like one piece and you're done.
One big giant shed.
Hopefully it's more tasteful.
Yeah, definitely.
It was definitely more tasteful.

(01:15:56):
All right.
So my two takeaways, I agree with you that the conversation was breezy.
It was refreshing.
It felt like it flew by.
It was easy to talk to her about such an amazing topic.
And both of my takeaways kind of center around how patient-centered twin health really is
as a company.
I was super impressed the hyper-personalization of their digital twin technology, which is

(01:16:19):
really enabled by the fact that they have 3,000 data points per patient per day coming
in to their system.
And that includes not just biometrics, but also patient-reported data like what are their
preferences around meeting their health goals, what kinds of behaviors are going to help
them be successful, and what kind of choices do they want to make around their health.

(01:16:44):
And that, as she mentioned, like what am I willing to do, but what am I not willing
to do as a patient who's working on improving their metabolic health.
So, so impressed with that.
Also loved the scalability of the fact that digital twins can learn from one another.
So if you and I had similar genomic profiles and I joined the platform or I became a member
of Twin Health, I could be matched with another profile that was similar to mine.

(01:17:08):
And my twin could kind of learn what's working for that patient, right, metabolically, and
and kind of coach me into better health.
So I love that caring learnings forward from a big data standpoint.
And also just like the back loop to patients really tying into their goals, their motivators
in leveraging that power of data to help drive behavior change in a patient-centric way.

(01:17:33):
So this kind of gets into my next nugget, which is also a large piece of meat fried,
right?
It's not just one tiny little bite-sized popcorn chicken nugget.
We, like she talked about driving patient engagement through micro opportunities, right?
Change happens slowly over time, right?
Change happens by forming new habits.

(01:17:54):
And that is, you know, getting back to this whole concept of like, what are you willing
to change?
Or do you not willing to change?
How do you help yourself within your own paradigm of behavior change?
I think that's what she described it as.
And then this whole idea of gamifying the experience based on that paradigm.
So it's not like, oh, good, my A1C levels are right within the threshold that my provider

(01:18:19):
wants to see them.
Well, that doesn't mean anything to me, right?
It's more like, hey, I'm on my way to like having more time to spend with my kids or
my grandkids or I'm getting closer to my weight goal, right?
I think you really double down on this quote when we were talking to Lisa, which was, if
patients don't have a choice, then they are no longer accountable for their own health.

(01:18:43):
And it's not about driving accountability from a punitive standpoint.
It's like, hey, what do you really want to get out of this?
And how can you be at the center of that experience driving it forward, right?
What's going to motivate you to get what you want?
So I love that.
And with that, I will pass the plate of proverbial nuggets in your direction.

(01:19:07):
Oh, so I'm going to dump a couple of nuggets on that plate too and hand them off to our
listeners.
I love this.
There was a couple of moments, that one that you kind of mentioned there about if you don't
have a choice, you aren't going to be accountable and creating agency in patients in owning
their own activity, owning their own behavioral change or owning their own journey that really

(01:19:32):
tied back to parenthood.
And so there was a kind of general through line on that, that I really found interesting
through the conversation.
She's a working mom.
We're working parents as well.
And so I thought that was really a nice through line of the conversation.
But my nuggets, well, my first nugget, it was more around the types of data points that
they're pulling in.
And I had asked her at one point, if you could have any kind of data point continuously that

(01:19:57):
you're currently only getting intermittently, what would you want to get?
And that's when she really got into this concept of her preferred data point really being insulin
resistance and being able to see an insulin resistance regularly because currently they
get lab data every once a month or so and not really able to see the deposition of fat

(01:20:22):
or inflammation occurring in an ongoing way.
I found that to be interesting because not necessarily because of the data it's providing,
right?
You do need to have that information in order to see whether or not what you're doing is
having an effect or not.
But she mentioned something she said, but we're not there yet.

(01:20:44):
And we didn't dive into it.
And it made me want to dive into it because I'm really kind of curious, what did you mean
by saying you're not there yet?
I want to know, is it because we don't have the testing mechanisms to be able to do this
affordably and sustainably by people in their own homes?
Is the cost of these tests so high that they still have to be managed by LabCorp and LabQuest

(01:21:04):
and so on and so forth?
And we just don't have the technology to have an in-home test that patients can take
on a more regular basis?
Or is it because we don't have a reimbursement or a coverage mechanism in this country to
be able to do these things at home, again, going back to affordability?
So I don't know the answer to that.

(01:21:26):
But when you couple that with the fact that she also said, and all of this happens before
the disease rears its head to begin with, how do we prevent this from even occurring
to begin with?
How do we use a technology like Twin Health to upstream the behavioral change so far that
it's not even putting you where it's preventing the disease as opposed to reversing the ravishes

(01:21:52):
of a disease?
So that was all very curious to me.
The second big nugget that I took away from other than some of the things that you mentioned
as well was then when she was talking about or disease management really being medicine
and medication, she said that medicine is managing a number.

(01:22:14):
And that's not actually fixing what's the root cause.
It's not fixing the body's ability to use glucose for energy and instead going down
this other pathway toward fat deposition.
That's where Twin Health is really providing the value.
Because in medicine is just helping to process the glucose and all you're really doing is

(01:22:37):
kicking the can further down the road.
So you may be lowering your A1C by taking your meds and so on and so forth, but you're
not actually repairing the damage.
And in fact, you're not changing necessarily your behavior patterns that are causing the
damage to begin with.
And so it's truly just management of symptom, not restitution of bodily function.

(01:23:01):
So medicine is managing a number.
Twin Health is managing a person.
Right.
And I would say, I think that's, I love that part of our conversation with her.
And I don't think it's because your average primary care provider isn't interested in
helping patients with behavior change because they know that how they lead their lives is

(01:23:21):
really what's leading them to have this metabolic disease.
And it's more about like the system isn't set up to help that primary care provider help
the patient successfully change their behavior.
Right.
And so-
Well, no, because it requires such a high touch.
Right.
Exactly.

(01:23:42):
Engagement with a person to actually change behavior.
And primary care providers don't have time for that.
Right.
But I guess what I'm saying is it's not like they're naive to think, well, I'll give this
patient a prescription and everything will be fine.
Right.
I think they want to, they know what the evidence shows in terms of diet and physical activity

(01:24:04):
and sleep and all the things that Lisa was talking about.
But it's like, well, how do we actually work with our patients within a model with supported
bike technology to help them make those changes, right, to meet their goals?
And that's what's so great about this company.
Like honestly, I think it's the perfect combination of like learning theory and the psychology

(01:24:28):
around behavior change.
And it's, it's not, it doesn't limit itself to nudge science, right, which is annoying
and shaming in many cases when it comes to things like this.
So combining that with really advanced digital twin technology is like a seemingly a silver
bullet, right, this problem.
So excited to see where this company goes and how it grows.

(01:24:50):
But that's enough of my response to your fascinating nuggets, Elliot.
I want to thank our listeners for joining us for our final episode of Tech at the Limit
this season, season two.
I know, right?
Can you believe it?
We made it.
It's amazing.
I know, right?
It's kind of crazy.
And stay tuned for season three.

(01:25:11):
Hell to the, yeah, it's going to be even better than the first two seasons.
We want to thank you all for tuning in, supporting the show.
Make sure that if you like it, that you leave us a five star review and tele-friends.
And if you don't like it, tele-front of me just for God's sake, tell somebody.
Elliot, do you want to wrap things up?

(01:25:31):
Wrap it up.
Our final episode of 2024.
Wrap up that Festivus gift of an episode for our listeners with our health tech haiku.
Oh man, nothing I'd rather do in the present.
Oh my God, that's like the best combination of puns to end the season.
I love it.

(01:25:51):
Yes, I would love to send us off with a health tech haiku.
Are you ready?
Yes.
Cloned in data's light, a twin whispers truths unseen, healing through mirrors.
Oh, I could hear your inner theater student coming out.
I think you need to unleash them more often.

(01:26:12):
Thank you, Tech at the Limit listeners.
We will see you next year.
See you next year.
See you next year.

(01:26:33):
Tech at the Limit is produced by Sarah Harper and Elliot Wilson in consultation with ChatGPT
because they are masochists and also don't have any sponsors.
Yet, music was composed by the world famous court minister Evan O'Donovan.
To consume more hilarious and informative content by digital transformation and healthcare,

(01:26:54):
visit us online at Tech at the Limit dot fun.
And don't forget to follow us on LinkedIn, Twitter, Instagram and across the event horizon.
See you next time on Tech at the Limit.

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