The Bioinformatics CRO Podcast

Transcript of Episode 36: Bettina Hein

Disclaimer: Transcripts may contain errors.

Grant Belgard: [00:00:00] Welcome to The Bioinformatics CRO Podcast. I’m Grant Belgard and joining me today is Bettina Hein, the founder and CEO of juli Health. Welcome.

Bettina Hein: [00:00:08] Thank you for having me on, Grant.

Grant Belgard: [00:00:10] Yeah, we’re happy to have you. So can you tell us about juli?

Bettina Hein: [00:00:13] Sure. Juli is a next gen disease management platform that helps people manage their chronic conditions. We cover complex chronic conditions, and currently we cover asthma, depression and bipolar disorder. We’ll soon have chronic pain and migraine as well as rheumatoid arthritis. And what we do is we bring data silos together and analyze that data to help people find their triggers and give them recommendations to stabilize their condition. So what we bring together is five data sources. All the data from your smartphone, data from connected devices like your scale or your smartwatch. Third, environmental data like air pollution, humidity, sunlight hours, weather. Forth, your electronic health record data. And fifth, what ties it all together is patient reported data. So how you feel on a certain day, how many episodes of shortness of breath you had, how many times you woke up in the night. Just those kinds of things.

Grant Belgard: [00:01:24] It’s fascinating. How do you deal with and process the electronic health record data, given how heterogeneous it is? Or are you focused on markets with large national health care systems? Or how do you approach that?

Bettina Hein: [00:01:39] No, we’re solely focused on the US market. And what we do is we pull in so-called fire data. Fire is a health care information interoperability standard that is really valuable and coming more into play these days. And what we do is we have a fire server where we can pull this data in a JSON format and then put it into our database. And what our users have to do is they have to allow access to their health systems EHR. So if you are, for example at Massachusetts General Hospital, a patient in their system, there’s a patient gateway, you provide that login and then you can pull that data in.

Grant Belgard: [00:02:31] Do you do any QC checks on that or have you seen differences among sources and how reliable the data may be? Do you find it’s more dependent on providers?

Bettina Hein: [00:02:42] Well, all of the data that we collect has noise in it and certain values that don’t work. We only launched our app into the App Store in March of this year, so we’re still in pretty early stages, but we need to clean up that data. That’s always the case and we don’t need every single parameter. So right now what we’re doing is building up our machine learning models to see which data we need to train those and to get significant results that will help people with complex chronic conditions.

Grant Belgard: [00:03:21] And so when you were describing the set of indications that juli covers, it’s quite diverse. I was wondering if you’ve seen any transferability among those indications or if you’re kind of approaching it as every model is trained exclusively on its own and you’re not really carrying over any design principles and so on.

Bettina Hein: [00:03:41] We’re definitely carrying over data. And so the conditions that we’ve chosen are multifactorial and they’re also influenceable by behavioral change. Those are the two requirements that we have and what we try to help people and what we’ve seen in the feedback from our users and our marketing is that people that have these conditions, they go through cycles where they have flare ups and episodes and they’re very keen on figuring out what those triggers are. That’s their suffering. So this is why we’ve chosen these indications. What we see is really interesting that you can pretty much, even if you don’t know what condition they have, you can often see from their data what it could be. And one of the also really interesting early findings is confirming some of the research that our co-founder, Dr. Joseph Hayes from University College London has done, which is really interesting. We can see that one of the very much influencing factors for depression is air pollution. He wrote a paper on this and we did not expect to see this in our data, but we have a partner that brings us via API, very hyperlocal air quality data and pollen count data. And so when we pull this in, we can see that. And what Joe’s research had shown is that when there’s a spike in air pollution, 48 hours later, there are spikes in people in emergency rooms with suicidal ideation and other depressive episodes. And I’m flabbergasted that this early in our data collection of our company, we are already seeing that.

Grant Belgard: [00:05:41] In terms of identifying triggers, how much similarity do you see in that across patients? Is it just dramatically different patient to patient? But you’ll have these averages that maybe stick out a bit? Or do most patients tend to follow a roughly similar pattern?

Bettina Hein: [00:06:00] Well, it’s still in the early stages to say this definitively. There are individual patterns, But what we do see is that standard medical practice is reflected in our data. But we are definitely working on customizing that more, having the models fit the individual as well as fitting the population. So those are things we’re working on right now. And it’s early days, but it’s really exciting.

Grant Belgard: [00:06:30] Do you have any academic collaborators?

Bettina Hein: [00:06:32] Right now we’re running a randomized controlled trial with University College London to show the efficacy of our solution. It’s an ethics board approved study. The trial is registered. And we’re doing that right now. We kicked it off two weeks ago. We’re recruiting for that. We’re doing asthma and depression. So if any of the listeners want to join in on that, you can go to juli.co and take part in our study. So we hope that within the next few months, we will have that study completed and then showing that. We’re also starting to collaborate with researchers at Harvard who also have an interest in these quantifiable aspects of managing mental health, managing other chronic conditions.

Grant Belgard: [00:07:25] And what is this space look like? Who are your competitors?

Bettina Hein: [00:07:28] Well, the most so competitors are disease management platforms like Omada and Livongo, which is now part of Teladoc, things like that. And Mindstrong is a competitor in the mental health space. So we’re a next gen solution of this. A lot of them have focused on diabetes, diabetes type II and also some cardiovascular things. We have left that out because it’s multifactorial, but the treatment protocol is pretty clear, what you need to do to get better from diabetes type II. It’s a big problem, but it’s not quite the mystery that a lot of people that have these other conditions and autoimmune conditions have.

Grant Belgard: [00:08:20] Cool. And I noticed on your website you mentioned DNA analysis as one of the things that feed in. Can you comment on what juli does there and what the plans are for that?

Bettina Hein: [00:08:29] Well, that’s a little bit of selling ahead of what we have. That is part of what we want to do. It’s not built in yet right now. But what we plan to do there is pull in things that show for example, their DNA analysis that show which kind of medication would work for you. Because with these conditions, they’re oftentimes various types of meds that have to be tried out one after the other. So what we’re promising is that we can help shorten the time to stability and thereby on the ups and downs, the highest and the lowest parts are the ones that have the highest cost for insurers and employers. So we’re trying to lob off the tops and bottoms and keep people within a healthy range. And so if let’s say you have depression, what you typically have to do is you have to try out 4 or 5 different medications over the course of a year or two years, three years. We can shorten that by just six months by using multitude of input. We’ve already gained a lot for a patient.

Grant Belgard: [00:09:54] Do you have any plans to engage health care providers directly or insurance companies? I mean, everything I see on the website seems to be pretty consumer facing.

Bettina Hein: [00:10:07] Right now it’s on purpose to have it consumer facing because we’re building the number of users that we have in order to build our data sets to get feedback and it’s free right now. So we’re doing that to really prove out our thesis around this. And then the idea would be that we get a certain fee per life from an insurer or a fee per employee from an employer, and that we’re not quite sure yet where the physician patient interface will be, how much that can be integrated, because those are very complicated things. But the simple idea is that right before you have a provider visit, you can send your physician essentially an output of this is the longitudinal data, since we’ve seen each other last so that they can see in a way of exception reporting. Okay, what happened? The next step would be that a physician or a part of the care team can set alerts for each individual patient and says if they go out of bounds with their score, their juli score or a certain parameter, then we have to engage with them, call them in or have a telehealth visit because something seems to be going off track.

Grant Belgard: [00:11:34] What is the regulatory landscape look like around this? I know nothing of that.

Bettina Hein: [00:11:39] Right now there’s not much. I mean, you can get this FDA pre-clearance, but it’s not required right now in digital health. I think that will come. In Europe, for example, you have a certification that you have to go register your digital health solution and digital therapeutics so that then you can get billing codes to be able to get reimbursement. But in the US, that currently doesn’t exist. And so what happens in the US is that you look at what part can I slip into and which billing code do I fit into so that I can get reimbursed. I believe that that should be more structured, but it’s currently not the case.

Grant Belgard: [00:12:26] And juli is an all remote company, right?

Bettina Hein: [00:12:29] Yes, it is.

Grant Belgard: [00:12:30] Can you maybe tell us a bit about that? I think you were founded after all the COVID stuff started, but was that the plan from the beginning or did your plans have to change as the world changed?

Bettina Hein: [00:12:42] Our plans completely changed as the world changed. So in our company, two of the co-founders have never met in person. I have never met any of the employees in person and I’m an entrepreneur. I have always been. This is my third company. I used to be a sort of Oracle style, one building company type of person, and I cannot believe that I’m running an all remote company. I’ve totally changed my tune, have become from Saul to Paul in this regard. So yeah, it’s really interesting to do it this way. There are some very clear advantages, but there are also disadvantages to having an all remote company.

Grant Belgard: [00:13:31] Can you comment on that?

Bettina Hein: [00:13:33] Well, so the advantages are is that you have access to talent in the whole world. And with that, you also can have comparatively lower salary costs on average. The United States is relatively high wage country. Three of us, four co-founders are in Switzerland, very high wage company. But between us, we cover 13 time zones. So from Krasnoyarsk in Siberia to San Antonio, Texas, we have people in Sochi, in Valencia, in London, in Lagos, Nigeria, in Boston so it’s crazy. I just find it really cool to have this diversity of people from all different kinds of backgrounds. It’s totally fun. And we teach each other some of our languages and talk about we’re having this holiday right now. You don’t have that. So tell us about it, that kind of thing. So I love that about it. And another advantage is flexibility. I’m a busy person. I’m a mom of two elementary school aged kids. I am a star on a reality TV show in Switzerland. I have board memberships and I’m the CEO of juli, so I have a lot of things on my plate. But because we do this remote, I don’t have to constantly be traveling. I can really slot things in pretty tight. And that is great because having like board meeting here and traveling for that whole day was like spent on that. Now it’s two hours and I have time for all this other stuff.

[00:15:29] So I love that about it. I’m working from home right now. The school is right next to our house. Sometimes the kids come home during the day and say, Oh, I forgot this, I forgot that. I can be here and help them. And that’s really wonderful. That makes me happy as a mom because I’ve been a CEO of tech companies for a while and most of their childhood, their nanny would have been the person to do that. And now I can be that. So that’s great. The disadvantages are that there’s not enough this bonding environment. Company culture is really important for a startup because people need to work so closely together and everybody needs to bring their whole self in to the company to work because we have to wear a lot of hats and we have to figure out who has what talents apart from their strict job description. That’s a little harder when you don’t have the cross pollination of being in the same office. You often don’t know that people have this special skill that you didn’t know about. You have to really make time to build a company culture, whether you’re leading your department or whether I do that as CEO, be very diligent about checking in with your people, having your one on ones and seeing where they are. Because if you don’t see that someone’s down in the dumps and can’t concentrate or whatever, seems sad. If you don’t get a handle on that, you can lose people pretty quickly.

Grant Belgard: [00:17:15] What tools do you use to try to mitigate that icebreakers video or Slack? Or what’s your tech stack for communication and company culture building in a remote company?

Bettina Hein: [00:17:29] We’re not currently using any super specialized tools. We use Slack, we use Zoom, we use notion where we have a wiki about the company and you know, all the different things. But that’s pretty much what we run the company off of. We try to have socials. Last week we had one where everybody had to make their favorite dessert from their country and eat it during the social and then explain what it is, why they like it, why it’s special in their country. So that was thing. We played two truths and one lie because those are interesting anecdotes from people’s lives. So they’re just fun things that you can do like that. We’re starting to do more of that. And I am organizing right now a get together for August. So keep your fingers crossed that despite COVID, we will be able to meet all of us somewhere. It’s right now very hard to say. But I think that if you’re a remote company, you should have regular touch points. I even had that when I didn’t run a remote company. My last company was a software company and advertising technology and we had offices all over. We were headquartered in Boston. We had additional offices in New York, San Francisco, Dallas, Chicago, London. And what I did and this was a cost that I incurred, that we incurred as a company, but it was very, very deliberate, is that we flew in people every quarter for our quarterly kickoff and it was expensive, but that’s where the magic happened. We had fun, things that we did. We had group discussions with people that were in the certain area, cross-functional ones. We talked about our strategy and industry outlook. We brought in guests. It was a real all encompassing thing for two days every quarter and people loved it. They were like, that made them so motivated. And once this whole COVID thing dies down, we’ll definitely invest in that.

Grant Belgard: [00:19:53] Yeah, it seems like remote work has been more difficult through COVID than in ordinary times, even though it was forced on people because a lot of kids were home from school who otherwise wouldn’t have been and so on and so forth. What do you anticipate changing as the world starts to get back to normal? Are there any things that you anticipate will get easier and is there anything you anticipate will get harder? What do you think will change?

Bettina Hein: [00:20:23] Well, what will get easier is that you can have the get togethers. And I’m really hoping for that. What will also get easier is that a lot of the normal life resumes where you have after school activities and camps and things like that running again. And I was lucky my kids go to school and in Switzerland and I’m a couple of months a year I’m in the US. But we only had the kids out of school for about three months last year. And then from the fall on, they’ve had full instruction in school, full time. And I’m extremely grateful for that because when they were home and we were homeschooling, it was for my husband and it was a nightmare. They didn’t have Zoom school and it was just really, really challenging. All the companies that we work with needed so much more support. People were like freaking out about getting PPE loans or other COVID things, and it just all had to become real quick doing emergency rounds of funding etc. It was just a nightmare. What I anticipate will get worse is the business travel is going to ramp up again.

Bettina Hein: [00:21:53] And since I have a B2B company, we need to sell to large insurers and employers. That means going places. And that’s hard. And when I founded this company, I wasn’t quite sure how we would do the monetization. I always hoped for a B2C business model, even though I’ve done B2B companies my whole career, but because I always think, Oh, that’s going to be easier, we can do that from any location. But alas, I think I meant to be a B2B entrepreneur. And so that will ramp up again. What I hope will stay is that people are more cognizant of other things that go on in our lives and more accepting of when kids come in and disturb a meeting. That used to be really hard for me. And I didn’t want people to perceive me as unprofessional or understaffed in my household, delegating the children during work things to somebody else. But now people have just gotten used to it, that men and women have families and they have obligations. And so I think there’s been a lot more reckoning around that. And people understand each other’s lives a lot better.

Grant Belgard: [00:23:20] Yeah, so I’ve been working remotely basically my whole career and I would say that’s definitely been my observation. This was weird a few years ago, but it’s totally the norm now and nobody thinks twice. If you have to put yourself on mute and turn it around and say something to a kid or even give them something to do in the office while you’re on a call.

Bettina Hein: [00:23:45] Yeah, we often hear dogs in the background and stuff that before it was this terrible and they have like, how unprofessional. And now that’s changed. You can see here my home office in my background because right now we’re seeing each other on video, not just an audio. So you have a little bit more context around me than if we just met in a random meeting room.

Grant Belgard: [00:24:16] And so talking about your history with B2B companies and so on, let’s explore that a little bit more. Can you tell us about your career path and what influences you maybe had along the way that ultimately led you to found juli?Because I mean, you’ve been in tech for a long time, but I believe this move into health tech is newer, right?

Bettina Hein: [00:24:33] Yes, it is. So I like to brag that I’ve never had a real job. So I founded my first company right out of graduate school. I was a spinoff of the Swiss Federal Institute of Technology in Zurich, maybe familiar to some of your listeners. We were a spinoff of The Signal Processing Department and we made text to speech software. My second company I founded out of MIT, and we became eventually an advertising technology. Software that helped big brand advertisers optimize their video advertising placements on YouTube and Connected-tv and other platforms. So now I’m doing juli, speech technology that goes into mostly cars and cell phones, ad tech, now health tech. Why? Like, what’s the commonality there? Well, the commonality there is that all of these companies used large amounts of data and applied machine learning or artificial intelligence techniques to optimize the results out of that. My first company, we had a lot of speech recordings and we had to make natural sounding voices out of that. And this was at the beginning of this this century. But we already then used neural networks to do that work with a second company flexibility. We were one of the pioneers in YouTube advertising. We were like in the alpha and beta of that even coming up, and we did contextual targeting. So we sucked in a lot of data from different APIs to show our advertisers how they could win in the auction. Well, actually we did that automatically and the Google or YouTube advertising auction. We helped them do organic optimization because we could see what was really interesting to their target demographic. And we could also very interestingly show them the trends that were happening ahead of them actually creating products around that.

Bettina Hein: [00:26:58] So that was another application of AI and machine learning. And now with juli, we’re doing it again. As I mentioned earlier, how I got into it was from personal experience. When I was doing my second company, I had two kids while being the CEO of a strongly growing company. My first child, our daughter was born prematurely and that was because I had had such a normal pregnancy. That was a huge shock to my system and I could not sleep for the next year and a half. It was really, really terrible. And I went to my GP and he said, Well, you’re breastfeeding, I can’t give you anything. I did that twice and I was just going insane. Because as a CEO of a company, you have to be alert and you have to be performant. So what I started doing was that I wore the sleep monitor, which was actually a headband from a company called Zeo, which unfortunately doesn’t exist anymore. But I could monitor my sleep very exactly and see when I woke up and what phase of sleep I was in. So I hacked myself back to health and figured out what to do, despite my doctor not being able to help me. What that then inspired me is to track other things. As things got on, other difficulties in my life emerged and I was cobbling together different sources of data, my digital scale, my sleep monitoring, a journal, write certain symptoms, my electronic health record. And I was so frustrated as a consumer that I couldn’t bring all of this together. And so I thought, well, there we go. If you don’t find what you need in the market as an entrepreneur, you can create a company that does just that.

Grant Belgard: [00:29:03] It’s really interesting. And I see you did a master’s degree after you’ve been this successful serial tech entrepreneur. You went back to school to study comp sci and AI at Georgia Tech. Can you tell us about the timing of that and what your thinking was behind that? And is that something that you found helpful? Is it something you would recommend to others?

Bettina Hein: [00:29:23] I’m a very curious person and I like to learn things, but I’m also kind of a procrastinator and need a more structured environment to bring myself to really get into new materials. So doing a master’s degree is a great way to do that. Yes, my husband teases me that I’m a degree collector because this is going to be my fourth master’s. But whenever I have a break in the action. In 2018, I handed over my CEO duties at flexibility to a professional CEO. And so I decided, okay, what am I going to do? And I’ve always really wanted to have a degree in computer science because back when I was the college age, girls were not encouraged to take those routes, actively discouraged actually from people in academia. And I always thought that I had made a mistake in not going down that route because I was pretty quickly bored with what I was doing. But I’m not a quitter. So I finished all those courses of study. But I’ve always wanted to go further into computer science and this is allowing me to do that. It’s great fun. It’s obviously challenging to do that next to a company and boards and two children. So I take one class a semester and I mostly do that on the weekend. I’ll do half a day on Saturday, half a day on Sunday, and maybe something during the week. And I know that it’s going to take much longer than it would otherwise take, but that’s okay. I’m not in it to get a promotion at my job.

Grant Belgard: [00:31:20] Do you think this will be your last degree?

Bettina Hein: [00:31:23] No. Have you heard of a management guru called Peter Drucker? There we go. Peter Drucker, thanks for showing me that book from your bookshelf. Peter Drucker had a really interesting way of doing things of continually developing himself. And what he did from an early age on is that he had a focused topic. Every three years he would do something completely differently. And I sort of have taken that. And yes, people make fun of me for it, but I don’t really care. I like learning new subjects, and this is a vehicle for me to do that. Will I always do that, who knows, maybe I won’t do another one. But I will certainly continue to have these vehicles that allow me to get deeper into a certain subject matter.

Grant Belgard: [00:32:25] And as we’re running out of time here, if I can ask you, what’s your most contrarian opinion?

Bettina Hein: [00:32:34] My most contrarian opinion, that depends on which country I’m in. In Switzerland, one of my contrarian opinions is that I am for quotas and boards and representation of women in leadership positions. That is highly contested. I know it also is in the United States, but I believe that the government has an obligation to step in when there is market failure and has an obligation to advance our economies by allowing greater participation of women in the labor force.

Grant Belgard: [00:33:21] And how about with respect to the United States?

Bettina Hein: [00:33:24] I don’t know if this is a controversial opinion, but I am perpetually annoyed, like disgusted by the way that the government is structuring immigration. It’s crazy that if you’re an entrepreneur and you want to hire people, create jobs that you continually have to justify your presence in the United States. And I was on a myriad of different visas during my time when I lived full time in the United States, and it just felt wrong. It felt like there’s no appreciation for immigrant entrepreneurs, and that urgently needs to be changed. The strength of the United States is in its ability to attract the world’s talent, and immigration levels are currently at the lowest levels they have been since the 1940s. That is bad news for the United States. That’s bad news for the demographic development of the United States, for the economy, for entrepreneurship, for the international standing of the United States. And I would counsel the US government, Congress, the President, to take urgent action on that.

Grant Belgard: [00:34:56] Yeah, it’s timely. Just yesterday, Harry Hurst, the founder of Pipe, posted on Twitter about how he’s basically stuck outside the US for the next year because he can’t get an appointment at the State Department at the embassy because they’re backlogged from COVID.

Bettina Hein: [00:35:12] Yep. And some of my employees for example, are stuck in the United States because they can’t go home. And I was in that position as well. I could not go home to my home country because not during COVID, but while certain visa things were going on, we were prohibited from leaving or we probably wouldn’t have been able to re-enter. I remember that one of my fellow students at MIT, he had not been home for the entirety of his four years of undergrad. He had not seen his family because he was afraid he was from Indonesia that he would not be able to come back and jeopardize his education. That’s an abomination. You cannot do that to people.

Grant Belgard: [00:36:05] It’s awful. Yeah. What are you most optimistic about?

Bettina Hein: [00:36:10] I am most optimistic about innovation and health care. I think that lots of people are coming in to health care with fresh ideas. I think it’s speeding up. Innovation is speeding up in health care. And that’s going to help people lead healthier lives.

Grant Belgard: [00:36:29] On that high note, thank you so much for joining us. It is a lot of fun.

Bettina Hein: [00:36:31] Thank you for having me.