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    Special: "Why Now" for Digital Health (with Levels founder Josh Clemente)

    Apple's potential development of non-invasive technology for glucose monitoring offers an opportunity to revolutionize diabetes management and solve the global metabolic health crisis. Levels could build insights on top of the technology to help people contextualize.

    enApril 06, 2021

    About this Episode

    We dive into the fast-changing world of direct-to-consumer digital health, with perhaps the best person in the world: Levels founder Josh Clemente. (Shoutout to Ben Grynol and Michael Mizrahi from our LP community for introducing us!) Levels is on a mission to make consumers everywhere aware of their metabolic health by enabling anyone to track blood glucose levels with a continuous glucose monitor. Josh has had an incredible career, working as an early engineer at SpaceX and later at Hyperloop One before founding Levels out of a very real personal need. Join our conversation as we cover everything from Josh's time at SpaceX to why the market has changed for consumer digital health, and what the future holds for Levels. 

    If you love Acquired and want more, join our LP Community for access to over 50 LP-only episodes, monthly Zoom calls, and live access for big events like emergency pods and book club discussions with authors. We can't wait to see you there. Join here at: https://acquired.fm/lp/

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    The Levels / Digital Health Playbook is available on our website at https://www.acquired.fm/episodes/special-why-now-for-digital-health-with-levels-founder-josh-clemente

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    🔑 Key Takeaways

    • Direct-to-consumer healthcare companies, such as Levels, are changing the healthcare industry through innovative business models, while companies like Kevel are leading the way in providing effective advertising solutions in the digital age.
    • Perseverance and building relationships can open the door to your dream job. Take risks, embrace new challenges, and work hard with determination to achieve amazing feats like seeing your work launch into space.
    • Taking risks and breaking away from tradition can lead to innovation and success, as demonstrated by SpaceX's attitude towards failure and their willingness to try new methods.
    • The importance of a proper diet in maintaining physical and mental health, as demonstrated by the benefits of a high-fat, low-carb ketogenic diet in preventing oxygen toxicity, seizures, and promoting energy to the brain.
    • Continuous glucose monitoring devices are no longer expensive and difficult to obtain, making them an accessible tool for people without diabetes to monitor and manage their blood sugar levels. These devices can provide insights into energy sources and help identify macronutrient imbalances, aiding in personalized diet and exercise plans for optimal health.
    • Using CGM can help identify foods that cause blood sugar spikes, track glucose variability, and manage pre-diabetic conditions. It's a powerful tool to improve overall health and well-being by providing data-driven insights on the effects of cortisol, stress, sleep, and exercise on blood sugar levels.
    • The Levels CGM device can potentially prevent metabolic breakdown by providing insights on chronic lifestyle choices. By transforming into a behavior change tool, it can offer feedback to users and bring solutions to manage and prevent conditions.
    • Levels overcame regulatory challenges by combining telehealth and low-risk medical products, delivering collected data to physicians for consultation. Innovative approach has the potential for lifestyle benefits for people with diabetes.
    • Physicians can now use their preferred platforms and work across multiple states. Digital health has two categories: general wellness and medical experience, with friction being a challenge on the medical side. Innovation in the medical device and pharmaceutical companies shows potential.
    • The healthcare system is moving towards personalized care options through cash-only, direct-to-consumer models, to provide a quality experience to consumers. Innovative approaches, like Levels, deliver metabolic awareness that turns into habits for healthier lifestyles.
    • Walking after a meal improves metabolic fitness and Levels program educates about its importance. Their direct-to-consumer model will eventually expand access to all socio-economic groups and build a foundation of objective data.
    • Levels is revolutionizing the health industry by bridging the gap between raw data and actionable insights. With a focus on biometric and health data, they are introducing a subscription model that will provide ongoing value to customers while also creating a defensible moat for the company.
    • Real-time feedback and decentralization through anonymized data sets can lead to individualized nutrition solutions, rather than relying on policies. Gene-based nutrition recommendations don't provide a comprehensive solution. Challenges in non-invasive CGM technology include not compromising the Apple brand image.
    • Apple's potential development of non-invasive technology for glucose monitoring offers an opportunity to revolutionize diabetes management and solve the global metabolic health crisis. Levels could build insights on top of the technology to help people contextualize.

    đź“ť Podcast Summary

    Direct-to-Consumer Healthcare Companies and Advertising in the Digital Age

    Direct-to-consumer healthcare companies are revolutionizing the digital health ecosystem. Levels, a company that tracks blood glucose with a continuous glucose monitor, is one of the companies leading this charge. The founder of Levels, Josh Clemente, has a fascinating background that includes working at SpaceX as a Lead Life Support Systems Engineer. The business models behind these companies are changing the healthcare industry for the better. Kevel, the presenting sponsor of this episode, provides API infrastructure for custom ad platforms and has a long history in the digital advertising industry. Their founder, James Avery, started with an ad network called The Lounge and learned the importance of the right ad in the right place for a better ad experience. Overall, the digital health and advertising industries are constantly evolving and these companies are at the forefront of that evolution.

    Persistence and Networking: A Recipe for Success in the Job Market

    Persistence and networking are key to landing your dream job. Josh called and emailed everyone, including recruiters at other Elon companies, and even got his uncle to drop Elon's name to get a foot in the door at SpaceX. He started at an entry-level position, learned on the job, and gradually moved up the ranks. SpaceX was a small, growing company where employees had to be adaptable and take on new challenges. Josh's experience highlighted the importance of taking risks and being part of an amazing team. Even with success, each system is unique, and stress remains high. Ultimately, hard work and determination can lead to surreal accomplishments like seeing your work in action when rockets successfully launch into space.

    How SpaceX's "Nothing to Lose" mentality led to success

    SpaceX's success can be attributed to their scrappy and fearless attitude, in contrast to the conservatism of old aerospace. They operated with a 'nothing to lose' mentality and were willing to take risks to achieve their goals, even in the face of potential failure. This mentality was propagated by Elon Musk's relentless pressure on his employees to succeed. This culture of risk-taking has continued to present day, seen in SpaceX's live streaming of Starship explosions. The founder of Levels, Josh, developed this mindset during his time at SpaceX and applied it to the development of his own company. Overall, SpaceX's success and innovation can be attributed to their willingness to take risks and break away from traditional methods in the aerospace industry.

    Discovering the Benefits of a Ketogenic Diet

    Josh, a former SpaceX employee, discovered the benefits of a ketogenic diet through his research on life support programs. He found that a high-fat, low-carb diet generates ketones in the body, which can cross the blood-brain barrier and provide energy to the brain. He learned that this diet can prevent oxygen toxicity and seizures, and help a person live longer. This discovery prompted him to question his own diet choices, which were based on taste or other people's opinions. He began self-experimenting to understand where his energy was coming from and how to optimize it. The key takeaway is that a proper diet, not just exercise, is a crucial factor in maintaining one's physical and mental health.

    Using Continuous Glucose Monitoring Devices for Blood Sugar Management Beyond Diabetes

    Continuous glucose monitoring devices have been primarily developed for diabetes, but they can also be useful for people without the disorder who want to manage their blood sugar levels and avoid potential health problems. CGMs are biosensors that can provide insights into the energy sources the body uses and help identify macronutrient imbalances. While they were originally expensive and difficult to obtain, mass-market devices like the FreeStyle Libre from Abbott are now available at a more affordable price. CGMs can detect both glucose and fat as energy sources, helping users tailor their diet and exercise plans to achieve optimal health. While the devices were not designed for people without diabetes, they can still be useful for monitoring and managing blood sugar levels.

    The Power of CGM to Track Glucose Levels and Improve Health

    Using CGM to track glucose levels can be a powerful tool to learn about your body's metabolism and identify foods that may cause blood sugar spikes. Glucose variability is closely linked with cardiovascular disease, and dietary recommendations may not always be as healthy as they seem. CGM can be used as an accountability and education tool to transform lifestyle, understand the effects of cortisol, stress, sleep, and exercise on blood sugar levels, and manage pre-diabetic conditions. The power of data observation can help counter failure modes in complex systems and lead to meaningful insights that can improve overall health and well-being.

    The Levels CGM Device as a Prevention Tool

    The Levels CGM device has the potential to not only help manage conditions, but also prevent them by providing feedback on the effects of chronic lifestyle choices. The key value proposition is building an insights layer on top of the raw data, which can transform the device into a behavior change tool. Other devices like Whoop and Apple Watch have already done this by presenting rings and scores to help users understand their data. The epidemic of metabolic breakdown caused by chronic lifestyle choices can be prevented if people receive feedback on their choices, and the Levels CGM device can potentially bring solutions into people's lives.

    Innovative Approach to Making CGM Data Insights App Regulatory Compliant

    Levels, a CGM data insights app, faced the challenge of making the hardware accessible to its users as a class III regulated medical device. The rise of companies like Hims & Hers and Roman presented a new model of combining telehealth capability with low-risk medical products into a direct-to-consumer experience and inspired Levels to create a unique business model that is elegant and regulatory compliant. By building a relationship with an independent network of physicians and delivering collected data to them for asynchronous electronic consultation, Levels started providing an informational biometrics service. While the software is not currently approved for therapeutic uses, the approach is unique and holds the potential for lifestyle unlock for people with diabetes.

    Changes in the Regulatory Space of Telehealth since COVID

    The telehealth regulatory space has seen significant changes since COVID but many systems were already plausible before. Physicians can now be licensed across multiple states and can use their platform of choice. Prior to COVID, companies were primarily leveraging asynchronous capability, but COVID enabled physicians to correspond through written communication as opposed to being synchronous. Digital health is divided into general wellness and medical experience, with friction being a challenge on the medical experience side. Once post-diagnosis, the end-user goes through whatever experience has been built, with feedback and customer experience falling behind. The medical device and pharmaceutical companies have a great business model compared to the tech world and innovation in the space is showing great potential.

    The Shift Towards Personalized, Cash-Only Healthcare.

    The healthcare system is all oriented towards the insurance coding system, which forces everyone to conform and only have one option, resulting in people not using their healthcare data to make decisions about their lifestyle. However, there is a move towards hybridizing high-quality information, going cash pay only direct to consumer, and working outside of the three-party system to provide a premium option that can deliver a quality experience to consumers. The future of healthcare is a combination of traditional market forces and innovative approaches that unlock non-reimbursable, premium options that are actually price-competitive. Levels is an example of such a business, where people wear a CGM system, go about their life, and get metabolic awareness, eventually turning their lessons learned into habits.

    Improving Metabolic Fitness through Behaviour Changes and Education with Levels Program.

    Metabolic fitness is crucial for both physical and mental health, and simple behavior changes like walking after a meal can help improve it. The Levels program aims to educate people about the importance of metabolic fitness and offer a premium experience to a discerning audience to eventually expand access to those who need it the most. The program's focus on education and research is intended to build a foundation of objective data and inform people about the importance of metabolic fitness. By starting with a direct consumer model, Levels aims to demonstrate the efficacy of the program and eventually expand to enterprise and insurance offerings. Long-term success will require bringing down prices and ensuring access to all socio-economic groups.

    Levels Uses Real-time Data to Improve Medical Outcomes

    Levels aims to trigger a new market and innovation in the health industry by using real-time data, biometric data, and health data to improve medical outcomes. They are focused on improving the delta between raw data coming out of a device and behavior change that needs to happen. Although there is ground to be covered in hardware, the core focus is on improving the insightfulness and actionability of the data. Levels is also introducing a subscription model, which is the second tier of product, to get maximum fresh perspectives for feedback reasons and to down select for the most intent of members. The subscription part of Levels would become important over time, from ongoing value to customers, and also defensibility and moat for the company.

    Utilizing ongoing data sets for personalized nutrition needs

    Large data sets with ongoing data help drive better recommendations and insights, as seen in the success of Meituan. The future of individualized nutrition lies in real-time continuous feedback, decoding raw data into behavior change opportunities. By building anonymized data sets, a decentralized solution can be achieved, allowing each individual to solve for themselves instead of relying on legislation or policy. The uniqueness of the individual is multivariate, and 23andMe's belief that a specific gene can determine what to eat for lunch is misguided. While Apple is rumored to be working on bringing non-invasive CGM technology to their watch, the challenge lies in not breaking the skin, which could affect the Apple product image.

    Levels' Excitement for Apple's Non-Invasive Glucose Monitoring Technology

    Levels is excited about the potential for Apple to develop non-invasive glucose monitoring technology that could revolutionize diabetes management and improve population health. The company believes that non-invasive measurement technology will open up the space for future analytes and benefit their goal of solving the metabolic health crisis. The metabolic health crisis is a global problem affecting billions of people and requires a collaborative effort to address. Although Apple typically delivers hardware before software solutions, it provides an opportunity for companies like Levels to leverage the technology and build insights layer on top to help people contextualize. People can get in touch with Levels by signing up for the waitlist or checking them out on social media.

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