Episode 27: Does your doctor give you heartburn? Reimagining GI care delivery with Dr. Sameer Berry, CMO of Oshi Health

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello and welcome to another episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, chief marketing officer at Definitive Healthcare, and your host for this podcast.
As you might know, March is Colorectal Cancer Awareness Month. Don't go anywhere. I know we're in April right now, but a couple of scheduling snafus prevented us from getting this podcast into March, but this topic was just too important to ignore. In very belated honor of Colorectal Cancer Awareness Month, today we're going to talk about your stomach. Well, actually your stomach and the stomachs of the more than a 100 million Americans who received care for gastrointestinal-related issue in 2022.
GI is a hugely important topic, and there's a lot of complexity involved in correctly diagnosing and treating it. It costs the US healthcare system just a ton of money, by some estimates, more than $140 billion each year in direct cost, which is more than heart disease, mental health or trauma. And yet, for some reason, or maybe we know the reason, we don't talk about GI nearly as much as we talk about all those other topics.
To help us understand why and to talk about the massive changes happening in GI care delivery, I'm joined today by Dr. Sameer Berry, the Chief Medical Officer at at Oshi Health. Oshi Health is a virtual multidisciplinary GI company. The front page of their website has a great grab-you line, "Find lasting digestive relief." And after they hook you with that tagline, you'll learn like I did, that Oshi Health is a virtual-first gastrointestinal care clinic that integrates evidence-based medical care and behavioral health support, into a convenient, high-touch, data-driven care model.
Not only is Dr. Berry the Chief Medical Officer at Oshi Health, he's also a practicing gastroenterologist, so he is one busy guy, which makes me all the more appreciative that he's taken the time to join me today here on Definitively Speaking. Dr. Berry, welcome to Definitively Speaking.

Sameer Berry:
Thanks, Justin, and thanks for having me. I know March was Colorectal Cancer Awareness Month, but April is actually IBS Awareness Month. We still have two back-to-back GI condition months. And so, the scheduling snafu actually works both ways. We're still okay in terms of the months for GI.

Justin Steinman:
I love that. Thank you for making me feel better about that, and thank you for making people's stomachs feel better in the middle of this IBS Month. Before we get going, I want to take a moment and welcome a new voice to our show here. In addition to Sameer, I'm joined by Catherine Wright, senior director of product management here at Definitive Healthcare. Catherine's been here at DH since the company's very early days, and she has got a ton of experience in the healthcare industry. Catherine, welcome to your very first episode of Definitively Speaking.

Catherine Wright:
Thank you. I'm so honored to be here, and great to meet you, Sameer. Thanks for joining us.

Justin Steinman:
Sameer, we are so happy to finally get you on the show today. Not to hit you with a hard question right off the bat, but I'm wondering why GI care is so stigmatized. I rattled off some scary stats there in the beginning, but no one ever seems to talk about GI care out loud. Why?

Sameer Berry:
That's actually one of the things that got me interested in the field as a medical student, and it actually goes all the way back to my childhood. My father was a gastroenterologist. Back in the day, my mother was working. She traveled a lot for work. My dad would actually take me to the hospital with him on rounds. Back in the day, there weren't that many rules about those kinds of things. And I remember sitting in at the nurses station, hearing him ask patients about poop, and gas, and nausea, and bloating, things that would just make any child giggle, but I could hear the sense of suffering.
Even as a child, I heard these really funny words, funny symptoms, but in a very somber tone, and I could hear the patient suffering as well. From a young age, that really impressed upon me that there is this whole field that nobody talks about. No one likes to talk about whether their butt is itching, or whether they have poop issues as a young kid, but this can really bother people. It can be really impactful on patients' lives. And so from a young age, I was drawn to the fact that being a gastroenterologist allows you to have conversations with people that they wouldn't even have with their spouse, that they wouldn't talk to anyone about.
These are really sensitive condition areas. They're really sensitive physical exams. And most of the time you can't look at someone and tell by looking at them that they have a GI condition. There's a lot of hidden patient suffering that attracted me to this specialty because I wanted to help those patients. The stigma around it is really due to the fact that we haven't done a good job of treating these conditions, and giving patients the interventions that they need to feel better. You're seeing an increasing prevalence of these types of conditions, and the stigma is there, and I think, unfortunately, the stigma actually creates more suffering, more suffering than most people realize.
Some of the staggering statistics, April's IBS Awareness Month, patients with irritable bowel syndrome actually report worse quality of life scores than patients that are on dialysis. There's a tremendous amount of suffering that's here in this patient population. They've been told, unfortunately, by many clinicians that these symptoms are all in their head. It's largely due to the fact that we've just done a bad job of treating the condition and we've done a bad job of explaining to patients and other clinicians what the root causes are, dysregulated gut-brain signaling, things that we can get into in this podcast, but that's what drives a lot of the stigma unfortunately.

Justin Steinman:
How do we reduce it?

Sameer Berry:
It's changing. That's I think one of the most exciting things about GI. I think GI today is at a place where mental health conditions were about 10 years ago. 10 years ago, nobody would talk about their mental health conditions. Today, you have celebrities talking about them. It's very open in the workplace to be able to say, "Hey, I need a mental health day." Unfortunately, it's not very open to say, "Hey, I need an office that's closer to the bathroom, because I've uncontrolled IBS," or, "I had a really bad night last night. My Crohn's disease was really bothering me. Can I work from home today?" Those conversations are a lot more difficult to have, but they're changing because we're doing a much better job of explaining the impact of these conditions across the country.
The other thing is that money talks. We're starting to really realize that the true impact of these conditions financially is absolutely staggering. And so, employers and health plans are really starting to hone in and focus on what's going on with digestive conditions, as they start to see it creep higher and higher and higher on their list of priorities.
Lastly, I think patients are doing a much better job of advocating for themselves. Unlike other condition areas like diabetes, hypertension, high cholesterol, you don't feel those conditions every day. Patients suffering from GI conditions feel their symptoms every single day. And so the fact that they're able to better advocate for themselves, is also changing the landscape.

Justin Steinman:
Yeah, it's weird. I have 13-year-old twins and, 13-year-old boy twins, as you might imagine, they love a good poop joke, or 20. If someone were to come to one of their friends and be like, "I'm really upset. Something bad happened, or a mental health issue," I hope and pray they'd be sympathetic enough to offer their condolences. How can I help you? But I guarantee if one of their friends came and said, "I had diarrhea last night, there would be 20,000 diarrhea jokes that happen over the next 20 minutes. It's just something about the way we react to this topic versus a mental health condition.

Catherine Wright:
I do think we're seeing a growing trend on social media with people being more open about things like IBS, and what people are going through. Is that something that you've experienced? Have you seen a more generational difference in who you're treating and how they're coming to with their symptoms?

Sameer Berry:
A 100%. And unfortunately, that's actually a double-edged sword. And so while we do see the rising prevalence of conditions like inflammatory bowel disease, irritable bowel syndrome, creating more of an opportunity for us to advocate for those conditions, it's also unfortunately given an opportunity for naysayers in the market to push a lot of snake oil and quick fixes and cures. And with the advent of social media, this gets disseminated far more easily. It's like a wildfire. And so, if you look at actually the hashtag gut talk on TikTok, there are millions of videos purported by untrained individuals saying, I did this celery juice cleanse and it totally cured all of my symptoms. And again, because these patients are suffering because we're not giving them the tools they need to treat their conditions, patients are grasping for straws. And so it can be a double-edged sword, the advocacy component.

Justin Steinman:
This whole mental health versus gut health thing is really intriguing to me as we sit here and talk about it. If you came to me and said you were depressed, I wouldn't presume to try to counsel you. But if you came to me and said Your stomach's upset, I'd be like, "Take a couple times," or, "I'm an expert," be with my exactly zero hours of medical school. I got all sorts of things to tell you to make your stomach feel better. But it's just so interesting, people... I guess maybe everybody poops so they feel that way, but it's an interesting conundrum, don't you think?

Sameer Berry:
It is really interesting. Whenever I'm in a drug store or a grocery store, I always meander to the GI aisle to get a sense of what are my patients looking at when I tell them to go to the drugstore and pick up a drug, or what are they looking at before they come to me? And it is so overwhelming. There is microbiome pills and probiotics that are purporting certain things. There's various iterations of acid blocking medications. And so, I totally get what you're saying. A lot of people just jump towards that Tums or the medication again, because we haven't done a good job of understanding, well, what is the impact of lifestyle, of stress, of diet, the gut-brain access. We're just starting to learn about these things, and it's a really exciting time to be in the field, because I think we're right on the cusp of a complete transformation in how we care for these kinds of conditions from a medical perspective as well as the advocacy components that we just talked about.

Justin Steinman:
So, talk to me about that transformation. What does that mean?

Sameer Berry:
Yeah, I think one of the biggest transformations, of course, is in the delivery of GI care. And this is actually the question that led me to start Oshi Health along with my other co-founders there. I remember training in a GI clinic and seeing patients all day, having 12 or 13 patients on the schedule, really sick patients. And I had patients who didn't need to see me at all, who had really simple concerns, who could somehow get in within a couple weeks. And I had other patients who really needed to see me almost weekly, but couldn't get in for months, either because of insurance issues, or travel issues, or work issues. I had patients who couldn't get their medications. I had patients who couldn't see a dietician or a psychologist, even though I knew that's actually what they needed.
And a colleague of mine, we were sitting in the doctor's room late at night finishing up our notes, and she was on the phone with an insurance company trying to get an endoscopy schedule. And we just sat and stared at each other after she got off the phone thinking about, could you design a system that could make it more impossible for us to do our jobs? I don't think you could. We just sat there banging our head on the wall. We have all this training, we know exactly what these patients need. In many cases, it's cheaper to give them what they need than what we can order, but the system only lets us order CT scans, MRIs, colonoscopies, endoscopies. We can order that with a click of a button, but if I want to see my patient once a week, that's almost impossible.
And so the GI system today, healthcare in general, but subspecialty care for complex conditions like gastroenterology, like hepatology, is designed around episodic appointments and procedures. But appointments and procedures are not what get people feeling better. Those are a component, but they're not what's proven to really heal people. And so, that's when things really changed for me at a personal level where I really said, okay, I want to start working on these system issues. I want to start working on these challenges. To Justin's point, what's this transformation?
And I tried in all different ways within the traditional system of healthcare. I sat on hospital committees, published papers, spoke at conferences. I've worked in academic centers, the VA hospital, private practice, worked in public policy with Governor Dukakis in Massachusetts, looking at ways that we could look at changing health policies. And the one thing I learned from all of that was that the current system is just flawed to its core, and we really just need to scrap that entire thing, throw it away, and start from scratch. And that's what led to four years later now delivering that type of care at Oshi Health, where we've designed a new system from the ground up that includes the right IT infrastructure, the right technology, the right reimbursement model, the right clinician incentives, the right clinical workflows. What's the right clinical model? What's the right cadence to see patients every few weeks? What's the right way for patients to be able to message with us?
Designing all of that from the ground up is what I came to believe was the only way to avoid another late night in the hospital where I was banging my head against the wall thinking, why can't I just get the patients what I know they need? And so, that's a long way of answering your question Justin about these transformations. But the reason I gave that story is because when most people think about transforming a field of medicine, they think about a revolutionary new surgery, or a revolutionary new medication. And while we need more of that in GI, and we should continue to do that type of innovation, what we really need is changing the care delivery model because today that is really the core of what's wrong, and that's really what I've dedicated my life's work to now.

Catherine Wright:
One of the things that really struck me about Oshi Health is how you focus on the interdisciplinary nature of it and specifically looking at, you think GI is really focused in one area, but I think what really comes through your site and your care is, you need to talk to a nutritionist. Do you need to talk to someone that can help you with your mental health? So, could you tell us a little bit about why it's so important that this is interdisciplinary, and how does that complicate the care, and what is Oshi working to do to try to streamline that for patients?

Sameer Berry:
Yeah, Catherine, that's such a great question, especially the part about how does that complicate the care? Because it's one thing to know that multidisciplinary care is the way to improve outcomes in GI. Scaling that care from an operational perspective has a lot of unique challenges, and that's part of the reason why we haven't seen it happen until now. We've known for decades through research studies, that multidisciplinary care where you give the patient more than just the physician, improves outcomes, reduces cost, and improves patient experience. This has been shown time and time again across various GI condition areas.
So, we've seen it in inflammatory bowel disease, we've seen it in refractory disorders of gut brain interaction. We've seen it in undiagnosed conditions, reflux. The problem is scaling access to that type of care has been very challenging, not only because it's not been traditionally covered by insurance, but if you think about traditional brick and mortar GI care, it's just not set up for a patient to have the number of touchpoints they need to work well with a multidisciplinary care team.
And so, I don't think anybody who's listening to this podcast would need convincing that multidisciplinary care is superior. If you take a patient and you give them access to a dietician, a psychologist, a health coach, a care coordinator, a social worker, that's obviously going to be a better experience than if they're only seeing the physician. And it's not only a better experience for the patient, it's a way better experience for the physician. Because back to my story, without that model, the physician is playing the role of all of those care delivery team members. They're training and teaching the patient about diet, and teaching the patient about stress, and calling the insurance company, and trying to help them with behavior change. And that's what drives burnout. That's what's made it so difficult to be operating a GI practice today.
We looked at Oshi, we looked at all this evidence that had been done. There's even actually RCTs, so prospective gold standard level evidence showing that multidisciplinary care is superior. We looked at all this evidence and we thought, the challenge in scaling this type of care delivery is that it's been relying on in-person care delivery workflows. And going to see your team, your clinical team, every one or two weeks, is really challenging to do in-person. And so we thought, we have all this evidence that multidisciplinary care works, let's digitize it, put it into a virtual first format, which allows the patient to contact us in a once a week and quickly iterate on their care plan and feel better. And it allows GI practices to actually deliver this type of care, because they're not set up to see patients every one or two weeks. So, doing that component digitally works really well.

Justin Steinman:
Interesting. I want to come back to something you said a few minutes ago, which is the healthcare system is flawed to its core. I wrote that down here in my little notes as you're talking. And I would say, you're the latest in a line of frustrated doctors, if you will, who've joined us here on Definitively Speaking. You're at least the fourth frustrated doctor. You may be even more than that. We're fortunate to have a lot of chief medical officers on here. But what you were talking about really rang a bell, because a few episodes back we had Dr. Andrew Norton, the Chief Medical Officer at OncoHealth on the podcast. And Andrew and I discussed what he was called, the perverse incentives of oncology care. The fact that many oncologists are paid based on a percentage of the cost of the drugs they've prescribed.
So, when oncologist is perversely incentive to prescribe a more expensive chemotherapy drug, because he or she will make more money. At the same time that we're sitting here talking about taking money and waste out of the healthcare system. And he was talking about how the healthcare system is flawed. Now, you've talked about it as flaw, do you see perverse incentives existing in GI care as well?

Sameer Berry:
100%. And it's unfortunate, but I think if we take a step back, GI practices are completely overwhelmed today. The average age of a gastroenterologist is approaching 60. And GI doctors are completely overwhelmed, largely because of the rising prevalence of GI conditions, also because we've reduced the screening age for colorectal cancer from 50 to 45. So, there's tremendous more need for colorectal cancer screening and colonoscopy. And GI, because of the rising cost, we talked about the direct cost associated with GI approaching $140 billion a year. That's more than we spend on mental health. It's more than we spend on heart disease. It's more than we spend on trauma. And so health plans start to look at that high cost and they apply very blunt instruments to reduce that cost, which are unfair when it comes to thinking about this from a clinician's point of view. What are those blunt instruments? Blanket downward pressure on procedural reimbursement.
So, we've seen about 20% cut in GI CPT codes over the last 10 years. UnitedHealthcare just announced nationwide blanket prior authorization on all endoscopy. So, what does that lead GI practices to do? It decouples the reimbursement incentive from value for the patient. And it creates a lot of administrative focus on zero sum competition, shifting costs from the hospital, to the GI practice, to the ASC, and just studying the coding system to try to game the system. There are a lot of perverse incentives in GI, and that's not unique to GI. That exists across the healthcare system. Like I mentioned earlier, I can order a procedure, a high cost procedure within one or two minutes. For me to get a patient to see a dietician, or a psychologist, or a health coach would require phone calls, letters to the insurance company, a lot of extra effort and work.
And even what I'm reimbursed for as a gastroenterologist, if a patient comes to me and I want to spend 45 minutes really digging through their medical records, listening to their history, trying to get a sense of what's actually going on, that just doesn't pay. What pays the bills at a GI practice is more endoscopy, more infusion, more imaging. And so, humans respond to those incentives and that's what ends up happening more and more despite us knowing that that's not really what gets patients feeling better. And the more I unravel this Gordian knot, the more perverse incentives I find, the more challenges I find, the more struggles on the clinician and patient side that I found. And again, that's what led us at Oshi Health to just say, "You know to help at this. Let's just throw all this away, create a blank canvas and totally start from scratch, because there's no way we can continue to make incremental improvements to the current system and hope that things will get better." We've been doing that for decades and seeing basically no change in the cost or outcomes or patient experience in GI.

Justin Steinman:
How do the health insurance companies feel about you guys? Because it sounds like you just laid a lot of blame at the foot of healthcare insurance companies.

Sameer Berry:
I have a lot of colleagues that work in health insurance, and they're really trying their best to do the same thing that clinicians are. I think health insurance companies get a really bad rap, and I don't want to get into that, but I think the right way to move-

Justin Steinman:
Oh, I do. I'm going to take you there, but keep going.

Sameer Berry:
We can go there. I think one of the things that we have to think about when we're starting a new system is, looking at all the stakeholders in a realistic way and thinking, what can we do to get this care moving forward? Too often I talk to clinicians and we get too emotional about thinking, "Oh, the health insurance companies are to blame for everything. And to hell with them, and we should just do direct specialty care or cash pay care." It's just, that's not going to work. And so, from day one at Oshi we said, "We can't just build around the system. We have to take the long, slow path of working with health plans, working with insurance companies, to explain and demonstrate the true cost of GI care, where the opportunities for cost savings are, how there's going to be a return on investment.
And one of my colleagues, actually, the metaphor that he used was really interesting. I was speaking to a GI doctor, and we were talking about, why don't you guys just sell directly to patients? Patients would pay for this. Why not just ignore the whole insurance component, and just sell it directly to patients? And he said, "What you guys are doing now are just taking a machete to the rainforest, and just building a whole new path that doesn't exist."
And that's really what it feels like, because we have to go to each health plan and each geography and explain to them, looking at their data, showing here's the true cost of GI care in your patient population, and here's where you can actually improve outcomes and reduce your cost by avoiding waste, to have it be a win-win for patients and the health plan. And that's really, I think, a core component of what we're doing at Oshi, is getting these services covered in network. But that's challenging, because insurance companies don't really have a true understanding of the costs in GI. And again, that's why they go back to using those blunt instruments of let's just cut the procedure reimbursement across the board, or let's just use prior authorization across the board. That does nothing to really get patients feeling better. It just disintermediates care between clinicians and their patients.

Justin Steinman:
So, I worked at an insurance company for four years, so I can ask this question. I ran product management, so I got you. Why do a health insurance companies get a bad rap?

Sameer Berry:
I think it goes back to that disintermediation component. They're seeing the cost of GI care rise precipitously, year over year, as the prevalence increases, as we have newer technologies that we should be embracing because they can help us treat more patients. But knowing when to use those technologies is key. And I think they get a bad rap because they don't have a true understanding, again, of the costs in GI, because there's a lot of coding obfuscation. So, unlike other condition areas like diabetes or hypertension, where you can measure a number and diagnose someone, this person has hypertension, this person does not. Diabetes, you can prick someone's finger and get a direct reading as to how they're doing. You really can't do that in GI. These are really vague symptoms, there's no definitive diagnosis. There's a lot of overlap of symptoms. A patient with irritable bowel syndrome, a patient with Crohn's disease and a patient with lactose intolerance can all have the same symptoms.
So, even if you look at it from a symptom perspective, there's a lot of variation. So well, why is that important to the insurance company? The reason is, is because the way insurance companies measure costs associated with certain conditions is they do claims analyses. And when you look at claims in GI, you do not get an accurate picture of what's really going on. And so, insurance companies have no idea how to have optimal resource allocation when you're looking at claims. That's what makes it really challenging. And then, I think that's what leads them to have a bad reputation when it comes to practicing gastroenterologists. But at Oshi, we're changing that.

Justin Steinman:
Interesting. I'm glad you brought up claims and despite the fact that you just said that claims aren't an accurate way of measuring it, I actually did some research before this and pulled some data, because we'd like to be data driven here on Definitively Speaking. So, one estimate that I saw found that there are roughly 311 million claims filed in the US in 2022, across both commercial insurance and Medicare, that included a GI diagnosis code. Those claims covered roughly a hundred million patients, so almost three claims for every single patient. And then according to data that I pulled from our data set, we saw the number of GI medical claims in the US grew roughly 13% from 2020 to 2022. So A, how do you feel about that three claims per one patient ratio? And B, why do claims for GI grow 13% over a two-year period? What's driving all that?

Sameer Berry:
So the number of claims increasing in GI really is related to A, the prevalence of these conditions increasing, especially with as we get out of this pandemic, a lot of these conditions are driven by gut-brain dysregulation, and the more gut-brain dysregulation there is, the more patients are going to be suffering from disorders of gut-brain interaction, which increases the prevalence of these codes. The other issue is a lot of practices have resorted to driving volume to achieve revenue because of the downward pressure on their margins and because of the downward pressure on reimbursement, practices are starting to focus on driving volume.
And so, you're starting to see more and more claims arise as practices adapt to a more challenging landscape in healthcare. There's more hospital consolidation, there's more payer consolidation. GI particularly has been the target of more private equity roll-ups as well. So, all of these macroeconomic forces combined, again, are leading to changing practice patterns in GI where you're going to start to see more zero-sum competition, more upcoding, and newer tactics to drive revenue as it becomes more challenging to operate these types of practices.

Catherine Wright:
So, knowing that Oshi's looking to do things a little bit differently, could you share with us some of the outcomes that you've seen, knowing you're just four years into the journey, but what wins and successes have you experienced?

Sameer Berry:
I think the biggest wins that we've experienced to date are our insurance contracts. And so, getting these services covered... And when I say these services, getting multidisciplinary care covered by insurance, has been a huge win. Today, 20 million people across the country have access to Oshi services as an in-network covered benefit by their insurance company. Four years ago, almost no one had access to those services as a covered benefit. And so, today patients can sign up at Oshi, and get access to a dietician, psychologist, social worker, health coach, care coordinator, nurse practitioner, all working together under one virtual roof, all trained in GI, all focused on getting that patient feeling better. Getting these services covered by insurance was a huge win for us, and we're going to continue to expand those services as an in-network benefit for patients.
Designing those contracts with health plans, has also been really fascinating. The vast majority of GI care today has just done fee for service. There's almost no value-based care in GI. We've seen alternative payment models and novel payment arrangements really take off in musculoskeletal conditions, preventative care, even mental health, diabetes. But really nothing has been done in GI. And the only areas in GI to date that have had any component of value-based care, maybe 30 day bundles around colonoscopies or procedures, maybe some population health metrics around colon cancer screening, some chronic care management programs that are really just designed for revenue enhancement. But when you look at the entire spectrum of the specialty and you look at chronic conditions like inflammatory bowel disease and irritable bowel syndrome and reflux, it's all fee-for-service.
And so, Oshi went and designed the true first value-based contract, where we are at risk for a component of our fees based on hitting certain outcome measures. That's never been done before in GI. And again, that allows us to deliver care in ways that traditional brick and mortar practices just can't do. I have a fiduciary responsibility to make sure my patients are getting better. That can incentivize and unlock care delivery that we could never do. We can call our patients every day, we can send them food, we can send a phlebotomist to their home if they can't get to the lab, because we really want them to start feeling better.
Some of the other successes and wins at Oshi, that I think I'm most proud of are our prospective clinical trial results. And unfortunately, this is a broader topic, I think, across digital health and healthcare entrepreneurship. You're starting to see a lot of companies purport certain findings or demonstrate certain findings through a white paper or through an internal flawed and biased analysis. From day one at Oshi, we really wanted to take a very evidence-based approach and a very rigorous approach to clinical validation. And so, we worked with a core team of academic gastroenterologists to design and run a prospective clinical trial, looking at patients who enrolled into Oshi's virtual multidisciplinary program.
And then, OptumLabs actually ran a claims analysis comparing the patients who enrolled in Oshi to propensity match controls. And this was a really sophisticated match control group. It was matched on demographics, GI symptoms, GI comorbidities, non-GI comorbidities. These two populations were propensity score matched on prior year cost, prior year utilization, high cost medications, ER utilization, and we saw very similar differences between the two groups. So, this was a really apples to apples comparison. And what you saw at the end of the program was $7,000 in GI related savings per patient, and $11,000 in all cause savings per patient, after just nine months in the program. And what drove these savings? Well, about a 60% reduction in GI related ER visits, a 60% reduction in high-cost GI related imaging, a 40% reduction in high-cost medication use, and even some avoided surgeries, gallbladder removal surgeries and things like that.
So, all of this to say, this drives cost savings and that's important to getting this covered by insurance companies. Because if we can't demonstrate that, the insurance companies are not going to cover these services. Now what's even more important is that the studies show that we were able to do this with really high levels of patient engagement, really high levels of patient satisfaction, 90% symptom improvement compared to baseline and about a 3X improvement in quality of life, workplace productivity, stress and anxiety. And how did we drive those outcomes? We saw patients every two weeks. We communicated with patients asynchronously through messaging almost every other day. And our appointment duration is 45 minutes long and there's no incentive for our clinicians to order anything. They're incentivized to get the patient feeling better. So it's really, it's not anything complicated. There's no complex artificial intelligence or ChatGPT, or algorithms, or AI, or potions. There's really nothing mind-boggling here. It's more time with patients, the right incentives and the right clinical team, working together, giving patients the care they need at the frequency that they want, that gets patients feeling better.

Justin Steinman:
You mentioned potions. I feel like I should make a Harry Potter joke here or something, but I got nothing, so I'll just keep [inaudible 00:34:15]-

Sameer Berry:
We have a lot of potions.

Justin Steinman:
A lot of potions? Excellent. [inaudible 00:34:19] mad scientist pouring you titrating and missing stuff from my high school chemistry class. Let's pivot to talk a little bit about the role of the patient. What's the patient's responsibility for his or her own GI care? Are people as diligent about their GI care as they should be?

Sameer Berry:
That's a great question. One of the really interesting things about GI, and this is actually something I say in almost every call with an insurance company, because it helps them understand this condition area in a different way. In GI, it's the patient that's driving the utilization, the unnecessary utilization, because they're feeling their symptoms. Back to what I said earlier, patients with diabetes don't feel their symptoms, not usually. Not until things get really bad. Patients with high blood pressure, high cholesterol, a lot of these condition areas, patients aren't feeling their symptoms every day. So, they're not waking up in the morning suffering, driving unnecessary utilization to the emergency room, driving unnecessary utilization to functional medicine, or trying these unproven treatments. In GI that's the case. And so, we have to focus on educating the patient about their care. We have to focus on getting the patient feeling better as the first priority. That's what leads to trickle down benefits and reducing unnecessary cost.
So, what can the patient do? I think these patients have been suffering long enough. And when patients come, when GI patients come to these types of models, they are highly motivated to work with this team. And I think it's a breath of fresh air. We get feedback from patients that say, "This is the first time a doctor's told me, this wasn't just all in my head. This is the first time somebody spent more than 15 minutes asking me about my condition area."
The average appointment time in traditional brick and mortar care for a GI visit, is about 19 minutes. And the reason that is, that's not a knock on physicians at all. I work in traditional brick and mortar GI care as well. And so, I suffer from these challenges just as much as my colleagues do. We haven't set our system up to help clinicians spend the time they need with their patients. And so, GI doctors are forced to bang their head against the wall in the system that doesn't work. And so I think, patients can always do more to improve their health, but it's challenging to do alone.
And so, you really need a team that's working with you every step of the way to help you with the behavior change, help you to understand why can't you lay down after eating if you have reflux and maybe you come home late at night from work. Maybe you end your shift at 9:00 PM, you come home at 10:00 PM, you eat dinner and then you have to go to bed. So, how can we work with each patient that's so unique, every single patient's different to help them understand and help them comply with the lifestyle changes that's really going to drive their outcomes, that's what's been the most fun part of this for me, is really kind of designing a system that doesn't take a one size fits all approach.

Justin Steinman:
Interesting. So we've asked a lot of clinical questions, but I want to ask you a business question here. So, I saw you guys recently just raised a new fundraise. Congratulations. I's $30 million series B, right?

Sameer Berry:
Thank you. Yes.

Justin Steinman:
What was it like to raise money in the current capital environment?

Sameer Berry:
It was challenging. We still have a lot to prove, but I think investors and the market really are starting to take note of how these novel care delivery models can really drive not only benefits to patients and clinicians, but be an excellent business to invest in. If we can reduce unnecessary cost in the system, improve the experience for physicians and patients, and do it with attractive unit economics that allows you to do well and do good as well. But this was a very challenging time to raise capital. The markets are very tumultuous and volatile. The Silicon Valley Bank and other unfortunate news in the healthcare technology space of companies getting indicted and investigated, going bankrupt, growing too fast. So, that's really the ecosystem right now in healthcare technology and healthcare services in particular. What I think investors noticed about Oshi was we took a very diligent approach to clinical validation, to hiring, to expansion, to what states we operate in, to what health insurance companies and employers we work with.
So, we have not followed the mantra of go fast and break things. That doesn't work in healthcare. You have to be really diligent and mindful every single step of the way, of how you're going to approach your business. It's a highly regulated business, of course, and it's regulated on a state by state basis, which creates significant operational challenges. But when investors did their due diligence and spoke to us and the rest of the leadership team, I think it was very clear to them that we had thought through every component of what we needed to do to scale our business mindfully. And we didn't really have as much trouble as I think some of the other companies in the space are having in raising capital, because of the approach that we've taken from day one. And that's really a testament to the leadership team.

Justin Steinman:
So, obviously it is literally life and death, so you can't go fast and break things. So, what are you going to do with all your new funding?

Sameer Berry:
It's funny, we haven't really taken a celebratory approach. It was a couple days of we got it, we got the money, and then wow, we have so much work to do, let's put our heads back down and just keep building. I remember the day our press release went out, and we had a leadership team meeting, and we probably spent two minutes just saying, okay, this is great. The news is out. And we went right back to, what do we need to do now? How can we continue to build? How can we continue to streamline? How can we improve our clinician experience? What do our patients need that we're not offering them? What are the right people that we need to bring in now to get us to the next level? And how can we mindfully grow so that we don't compromise at all on our outcomes or cost savings?
So, that funding is really going to be used to help us expand into the states that we're currently in. I mentioned we're in about 20 states today. So, continuing to deliver this high-touch multidisciplinary care with a pretty broad clinical team, is expensive. And so, doing that the right way is also expensive. We're the only digital health company in GI that has our own in-house team of clinicians working together. We don't use any staffing agencies. And so, that's what we're using the capital for, investing more in our data analytics, investing more in our technology infrastructure, investing more in our provider experience, so making it streamlined and easy for our clinicians to see patients on the weekend, see patients in the evenings. Not have to spend so much time documenting.
And then also significant input investment into our back office clinical function. So, how can we use more technology to automate our quality and risk management? How can we use technology to automate our utilization management? How can we use technology to improve clinical decision support to our protocols that are in-house, of how do we actually get patients feeling better, looking at all the evidence that we've brought together in GI? So, it's an exciting time, but it's not really time to celebrate. It's more time to just put our heads down and focus.

Catherine Wright:
We've talked a lot today about how unique GI is. As you're scaling this new model and really proving it out, are there other specialties or therapy areas where you feel like this model may work in the future?

Sameer Berry:
One of the most interesting components of building this model in GI is, GI is a specialty that most people would imagine has a lot of in-person care need. There's a highly procedural field. There are sensitive physical exams that you have to do, which cannot be done virtually. And so, what Oshi has been able to prove is that this virtual first approach to complex chronic condition management can really be applied in almost any condition area, even condition areas that you would traditionally think have really heavy in-person care needs. And so, we're starting to see the emergence of these virtual first approaches to care delivery in other complex condition areas as well. For Oshi, I think we're going to be focused on GI. That's really our North Star. There's so much suffering there. There's so much work to do. So, that's really our focus for now.

Justin Steinman:
Well, Sameer, it's been fascinating. I could talk to you for hours. We'll have to have you come back and continue on. I'm definitely going to follow the progress of Oshi Health. Thank you for taking the time to talk with us today.

Sameer Berry:
No problem, Justin. Catherine, it was a pleasure to speak to you both. Happy to come back anytime.

Justin Steinman:
Yeah, this is a lot of fun.

Catherine Wright:
Thank you so much.

Justin Steinman:
And for all our listeners out there, thank you for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a conversation with Jeremy Kirsch and Steven Wisch, the founders of a company called Network Eye. Network Eye's put together an interesting little business, where they're bringing treatment for complicated retina disease to your local retail clinic. What's interesting to me about their business model is that they're a private clinical provider who are delivering clinical services in a third party retail store, like a CVS or Walgreens. Sort of feels like a NextGen clinical delivery model. And I look forward to exploring the pros and cons with Jeremy and Steven. I hope you'll join us.
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