As a part of my interview series with leaders in healthcare, I had the pleasure to interview Divya Chhabra. Divya is the COO and Founder of Dosis, an AI-powered personalized dosing platform. Before starting Dosis, Divya received her B.S. in Biological Engineering from MIT and was a Product Manager for B2B and B2C products at athenahealth.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Independent business ownership has always been an important part of my family and my upbringing. As a child, I watched my mother and father struggle to run their own independent business while raising me and my brother, who is also the co-founder of Dosis. We learned very early on that if you find the right people to count on, while working very hard on a mission that everyone on your team believes in, you really can overcome difficult challenges. I also saw that owning their own business gave my parents a certain flexibility and autonomy that is difficult to achieve while having a job. When I graduated college, like many people, I started a job, but a few years in, I gained a better appreciation for the benefits of business ownership that I’m sure my parents must have seen when they decided to start their business when I was a kid. So, my brother and I ultimately decided that it was time to take the plunge together and see if this could work. We put together our shared expertise — his in running a closely held business and mine in the healthcare space — and thought why not tackle something that affects millions of people worldwide, but also presents the kinds of interesting challenges that we both seek out as engineers.
Can you share the most interesting story that happened to you since you began leading your company?
It never occurred to us how busy clinicians are, and we first realized this when we were on a trip to Illinois. We were running around from clinic to clinic, with whom we had scheduled appointments. We were planning on meeting with practice managers and physicians, but many had last minute patient-specific incidents arise, that caused them to request to reschedule our meeting. As you may know, Dosis has a shared savings business model that directly aligns its incentives with the clinics — we help clinics improve their patient outcomes and reduce their cost, and it’s completely free to try out. Even so, it was difficult to get facetime with the clinics, largely because of their unpredictable schedules that are outside their control. That day, we were incredibly discouraged, thinking that our product may not have a market fit, since it seemed like prospective clients didn’t value our meeting. Today, we have a much better understanding of our clients’ schedules and know that a rescheduled meeting is not a sign of a lack of interest, but rather just a part of an industry where unforeseen and urgent patient circumstances arise.
Can you tell our readers a bit about why you are an authority in the healthcare field? (2–3 sentences)
As a product manager at athenahealth, I witnessed firsthand both the benefits and shortcomings of technology in healthcare. This experience, combined with my passion for building life-changing products that create a positive change in people’s wellness, push me to work toward revolutionizing the healthcare industry with personalized dosing. I’m currently working to improve care for more than 15% of adults in the U.S. that suffer from Chronic Kidney Disease (CKD), which is often caused by diabetes or high blood pressure.
What makes your company stand out? Can you share a story?
Many startups try to say that they’re bringing tech to the X, Y or Z space. That’s not just what Dosis does. Strategic Anemia Advisor, our flagship product for personalized dosing of ESAs, is not just an automated solution that cuts humans out of the process and avoids the kind of oversight and independent thinking that’s required in a dialysis practice. What SAA does is that it gives physicians and nurses the best possible tools that they can have in order to make the clinical judgements that they believe are in the best interest for their patients. Clinicians are not only able to reduce cost this way, but also deliver the kind of outcomes that are expected by patients and payers.
In working with more than 5,000 CKD patients to date, Dosis has enabled a 65% reduction in patient outlier hemoglobins and an increase in the percentage of patients within a hemoglobin target range, while cutting the amount of ESA used by 50%. In short, healthcare providers are reducing their ESA use and improving their patient outcomes.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
It’s 2019 and we see personalization everywhere we go: from ads, to news,banking and even drinking Gatorade. We all know that no two people are the same, and we’re seeing that technology can help us better cater to what makes you, you. We’re seeing similar personalization trends in the healthcare industry. uBiome uses machine learning to analyze your individual gut microbiome; Notable Labs offers personalized testing for brain cancer patients to help determine what combination of cancer drugs would work best for their particular form of cancer; and, of course, there’s 23andMe that sequences your DNA and provides users with a personalized report of their ancestry and disease risks.
To date, however, we haven’t seen an effort to personalize chronically administered drugs. Why is the dose for a drug that you’re taking daily, weekly or even monthly, not calculated based on your specific drug response? Dosis solves that problem. Our first product, Strategic Anemia Advisor (SAA), personalizes dosing for a class of drugs called erythropoiesis-stimulating agents (ESAs) that are used to treat chronically anemic patients. Often, these patients are dialysis patients.
SAA uses a patient’s previous hemoglobin levels and ESA doses to determine that patient’s unique response to ESA. Then, it uses the patient’s hemoglobin trajectory and unique drug response profile to predict the patient’s hemoglobin levels four months out. Lastly, it outputs a dose recommendation that minimizes the difference between the patient’s hemoglobin and desired hemoglobin target range.
By taking this personalized approach, providers are able to see an improvement in patient outcomes and a much more efficient use of ESAs, thereby reducing their patients’ ESA exposure and decreasing the cost of ESA to their dialysis clinic.
We’ve launched less than two years ago and are already in over 50 dialysis clinics, proving that dialysis clinics are ready for and excited about making this shift toward personalized dosing to improve their anemia management.
Are you working on any exciting new projects now? How do you think that will help people?
We’re working on expanding our personalized dosing offering to include personalized dosing for IV Iron and drugs used to treat Mineral Bone Disease (calcimimetics, phosphate binders and Vitamin D).
What are your “5 Things I Wish Someone Told Me Before I Started” and why?
- Sale cycles can be long; don’t get discouraged. We’ve had clients who initially expressed interest but didn’t have operational bandwidth to try out SAA until a year later. We didn’t get discouraged and instead just kept in touch, so that when they were ready, we were ready to bring them on board.
- Understand your clients’ day-to-day schedules and workflows. This allows you to better understand other concerns that may be more top-of-mind for your client’s than the problem you’re trying to solve with your product.
- Deeply understand how your product works and ensure everyone on your team does as well. This ensures that everyone on your team is able to provide input on the design for new features and help test new features. When working on a healthcare product, it’s especially important to have as many eyes on a solution as possible.
- Make sure you celebrate milestones. Our team had internal milestones that we wanted to meet and, once we met them, we were already working feverishly to meet the next one. It’s important to take some time to just sit back and appreciate how far you’ve come.
- It’s hard to replace in-person meetings. We’ve communicated over email, phone, video chat and in-person with our clients. By far, the most meaningful meetings have been those that were in-person. You’re able to get a glimpse of the other’s day-to-day life, which helps you better relate to them in future interactions.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high-income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
- Lack of interoperability. When the HITECH Act passed in 2009, there were high hopes that digitizing America’s medical records would break down barriers between hospitals, imaging centers, labs and outpatient clinics that prevent easily sharing medical records. This dream is far from reality. It’s still difficult to share medical records across different EHRs, which often requires a provider to order tests that a patient may have already had elsewhere, but whose results are not shared with that specific provider. This lack of interoperability both increases cost and impedes potential innovation. If there was better data-sharing between EHRs, each patient’s medical history would be more complete, allowing providers to make better informed decisions and allowing companies to offer innovative solutions powered by comprehensive, high-quality data.
- Fee-for-service. The US primarily uses a fee-for-service payment model, which incentivizes quantity of care, as opposed to quality of care. This inherently increases cost, as health systems are motivated to order more tests and procedures to increase revenue. The move to value-based care, where health systems are paid based on patient outcomes, is an encouraging step away from fee-for-service and has the hope to improve patient care.
- Lack of preventive care. In the US, there is not a strong focus on preventive care. Several chronic diseases could be prevented by placing an emphasis on good nutrition and an active lifestyle. The Affordable Care Act created the Prevention and Public Health Fund to provide investment for preventive measures, such as screenings and vaccinations. Still, only 20% of patients take advantage of at least 75% of preventive services.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Empower patient access. Patients should have direct access to their own medical records.
- Move toward value-based care. Reimbursement should be based on quality of care, not quantity.
- Emphasize preventive care. Payors should incentivize patients to take preventive care measures, which would be financially beneficial for the payor and medically beneficial for the patient.
- Increase access to care. Patients in rural areas are experiencing an increasingly sparse landscape for healthcare services. As an industry, we should explore how we can use telemedicine to reach these patients or use policy to incentivize healthcare services in rural communities.
- Increase interoperability. EHRs should be able to speak to one another, easily and quickly.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities, and leaders do to help?
We’re already seeing some of these ideas come to life. For example, Redox, hopes to address the interoperability issue by aiming to be a one-stop shop for EHR integrations. Apple is placing a big emphasis on healthcare and, in particular, allowing patients to access their own health records. In a move toward emphasizing preventative care, we’re seeing physicians prescribing fruits, vegetables and exercise. It’s encouraging to see so many people focused on improving our healthcare system.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Two of my favorite podcasts are How I Built This and Business Schooled. As a founder, it’s encouraging to listen to other founders’ stories, the obstacles they faced and how they overcame them. On Business Schooled, Lesson 2: Practicing Joy (and medicine) provided us with some ideas that we actually implemented internally. I also recently read Becoming by Michelle Obama, and her Let’s Move initiative has certainly had a positive impact on children’s lives and is largely focused on preventive care.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!